Background

Drain use for bariatric procedures with an anastomosis has been considered the standard of care for many years. With an increased use of laparoscopic approaches, the routine use of drains has been questioned. Our aim was to evaluate predictors of postoperative complications in patients who underwent laparoscopic bariatric procedures.

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) was queried for adult patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and BPD/DS in 2015. Only patients with primary bariatric procedure who had a leak test performed during operation were included. Primary outcomes were peri/postoperative complications, defined as presence of one or more of the following: leak, morbidities (cardiovascular, renal, respiratory, and neurologic), mortality or surgery-related infection. Demographics, preoperative comorbidities, length of stay (LOS), and intra-abdominal drain placed at the time of the surgery were also evaluated. Comorbidities present were each given a score of one and totaled for each patient, and were defined as history or presence of cardiovascular, renal, pulmonary, neurologic or obesity-related comorbidities. Chi-square tests and logistic regression were performed using IBM SPSS 23.0, α=0.05.

Results

89,793 patients (RYGB: N=32,288; SG: N=57,022; BPD/DS: N=483) were included in this study. Overall complication rates were 3.10% for RYGB, 1.60% for SG, and 2.30% for BPD/DS. Leak rate was 1.1% for RYGB, 0.5% for SG, and 1.9% for BPD/DS, p<0.001. Use of drains had a LOS of 2.1 ± 2.2 days versus 1.7 ± 1.8 days for no drain, p<0.001. For RYGB, analysis revealed that placement of abdominal drain and presence of preexisting comorbidities were independent predictors of postoperative complications (Table 1). Likewise, SG patients with preexisting comorbidities, elevated age or drain placement at time of surgery had a higher likelihood of developing postoperative complications. The predictors of postoperative complications analyzed in this study were not significant in the BPD/DS group. BMI, smoking status within one year, and gender were not correlated to postoperative complications in all three procedures.

Conclusions

Abdominal drainage and preexisting comorbidities increase the likelihood of developing postoperative complications in patients who undergo RYGB and SG. Age greater than 53 years was also a predictor in SG patients. Those factors did not seem to affect postoperative complication rates in patients who had BPD/DS. Gender, BMI, and if the patient had smoking within the last year, also did not affect complication rates. Routine drain use should be discouraged based on these data.