Analysis of factors predictive of gastrointestinal tract leak in laparoscopic and open gastric bypass.

HYPOTHESIS

Patient characteristics and comorbidities, payer type, and operative technique (laparoscopic vs open) predict the risk of gastrointestinal (GI) tract leak in patients with morbid obesity undergoing gastric bypass.

DESIGN

Retrospective database analysis.

SETTING

Nationwide Inpatient Sample.

PATIENTS

Between January 1, 2006, and December 31, 2008, patients who underwent open or laparoscopic gastric bypass to treat morbid obesity.

MAIN OUTCOME MEASURES

Factors predictive of GI tract leak using multivariate regression analyses.

RESULTS

A total 226,452 patients underwent laparoscopic (81.2%) or open (18.8%) gastric bypass during the 3-year period. Most patients were female (80.5%) and of white race/ethnicity (73.6%). The mean age of patients was 43.6 years; 30.0% of patients were older than 50 years. The overall prevalence of in-hospital GI tract leak was 0.7%. The GI tract leak rate was significantly lower in laparoscopic compared with open gastric bypass (0.3% vs 2.0%, P < .01). Using multivariate regression analysis, factors associated with higher risk of GI tract leak were open gastric bypass (adjusted odds ratio [aOR], 4.85), congestive heart failure (aOR, 3.04), chronic renal failure (aOR, 2.38), age older than 50 years (aOR, 1.82), Medicare payer (aOR, 1.54), male sex (aOR, 1.50), and chronic lung disease (aOR, 1.21). The GI tract leak rate was unaffected by race/ethnicity, hypertension, diabetes mellitus, sleep apnea, hyperlipidemia, liver disease, peripheral vascular disease, or smoking.

CONCLUSIONS

We identified multiple factors associated with the higher risk of GI tract leak after gastric bypass. Surgeons should use this knowledge to counsel patients and possibly alter operative plans in high-risk patients to minimize this risk.