Conference Coverage

Immobility implicated in increased complications after bariatric surgery

 

Key clinical point: Patients immobile before bariatric surgery could require closer monitoring for postoperative complications.

Major finding: Thirty-day mortality after bariatric surgery in immobile patients was 0.5%, vs. 0.1% for an ambulatory group (P less than .0001).

Data source: A comparison of 2015 MBSAQIP data for 145,741 ambulatory patients and 2,969 immobile patients before bariatric surgery.

Disclosures: Dr. Higgins had no relevant financial disclosures.


 

AT THE ACS QUALITY & SAFETY CONFERENCE

Immobile patients are at a heightened risk for complications after bariatric surgery, a large retrospective study has shown.

“The importance of this study is to help us as an institution, but then also nationally, to try to focus on quality initiatives to improve the complication rate and safety profile of these patients, who are incredibly high risk for bariatric surgery,” said Rana Higgins, MD, a general surgeon at Froedtert Hospital and the Medical College of Wisconsin in Milwaukee.

Dr. Higgins and her colleagues compared 2,969 immobile patients with 145,741 who were ambulatory before surgery. The most common bariatric procedure was sleeve gastrectomy at 56%. Another 30% had gastric bypass, 3% had the gastric band, and the remaining 1% underwent other procedures, such as biliopancreatic diversion with duodenal switch. The MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) defines immobility as a patient with limited ambulation who requires assistive devices, such as a scooter or wheelchair, to ambulate most or all of the time. In addition, with regard to negotiating stairs, immobile patients need a home lift or an elevator.

Dr. Rana Higgins, a general surgeon at Froedtert Hospital and the Medical College of Wisconsin in Milwaukee.

Dr. Rana Higgins

“What we found in fact is that nearly every postoperative complication was significantly increased in the immobile patients,” Dr. Higgins said at the American College of Surgeons Quality and Safety Conference. These patients were significantly more likely to experience renal failure (odds ratio, 6.4), wound disruption (OR, 4.5), unplanned intubation (OR, 4.3), and sepsis (OR, 4.3). “Almost every complication had an odds ratio over 2 in the immobile population, and all of these were statistically significant,” she added.

Only three complications evaluated by the researchers were not statistically different between groups: intraoperative or postoperative coma, stroke, and myocardial infarction.

Postoperative factors favor ambulatory patients
“After examining complications, we also looked at other postoperative factors, including length of stay, operative time, readmissions, reoperations, and mortality,” Dr. Higgins said.

Operative time was longer in the immobile group, about 102 minutes vs. 91 minutes (P less than .001). A meeting attendee asked what accounted for the difference. Dr. Higgins replied, “We’ll have to go back and look at our data. My hypothesis is that the immobile patients had a higher BMI [body mass index]. They may also have had other comorbidities that contributed to increased operative time.”

Hospital length of stay was also significantly longer among immobile patients at 2.3 days vs. 1.8 days in the ambulatory group (P less than .001).

The readmission rate was higher among immobile patients – 7.3% vs. 4.3% for the ambulatory group. The reoperation rate was higher at 2.6% vs. 1.4%. Both these findings were statistically significant as well (P less than .001).

Immobile patients had a statistically higher risk of mortality at 0.5%, compared with 0.1% among ambulatory patients (OR, 4.6).

A meeting attendee asked Dr. Higgins if her institution addresses mobility issues. She replied that there is preoperative education about the importance of ambulation, but the interventions are focused on ambulation in the postoperative period. “We order physical therapy, immediately postoperatively; typically the patients will receive it that day or the next day. We make sure patients are up and moving as much as possible, but there are limitations if they have limited mobility.”

The same attendee suggested preoperative physical therapy could help, even if only 2-4 weeks prior to surgery. Dr. Higgins agreed that would be a good quality initiative to explore in the future.

She had no relevant financial disclosures.

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