MBSAQIP database: are the data reliable?

Perioperative Outcomes of Staple Line Reinforcement During Laparoscopic and Robotic Sleeve Gastrectomy: An MBSAQIP Cohort Study of 284,580 Patients

BACKGROUND

This study evaluated the association between staple line reinforcement (SLR) and 30-day outcomes in patients undergoing laparoscopic (LSG) or robotic sleeve gastrectomy (RSG).

METHODS

Adults undergoing primary LSG or RSG with and without SLR were analyzed from the 2018-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) database. Baseline characteristic differences by SLR status for LSG and RSG were adjusted using entropy balancing. Multivariable weighted logistic and linear regression was then performed to examine the association between SLR and primary and secondary outcomes.

RESULTS

Of 284,580 patients, 88.6% (n = 252,035) had LSG and 11.4% (n = 32,545) had RSG, of which 63.7% (n = 160,545) and 50.8% (n = 16,541) had SLR, respectively. Compared to LSG and RSG without SLR, both LSG and RSG with SLR encountered higher adjusted odds of emergency department visit (AOR 1.08, 95%CI 1.03-1.10, p < 0.001; AOR 1.10, 95%CI 1.01-1.20, p = 0.029, respectively) as well as lower adjusted odds of leakage (AOR 0.85, 95%CI 0.76-0.94, p = 0.002; AOR 0.71, 95%CI 0.54-0.92, p = 0.011, respectively) and gastrointestinal bleeding (AOR 0.79, 95%CI 0.77-0.91, p < 0.001; AOR 0.77, 95%CI 0.70-0.84, p < 0.001, respectively). LSG with SLR was also associated with greater odds of unplanned intubation (AOR 1.52, 95%CI 1.16-1.99, p = 0.002) and mechanical ventilation (AOR 1.74, 95%CI 1.22-2.50, p = 0.002). RSG with SLR was associated with higher odds of intraoperative conversion (AOR 1.71, 95%CI 1.15-2.54, p = 0.008), and lower odds of acute renal failure (AOR 0.27, 95%CI 0.11-0.65, p = 0.003).

CONCLUSIONS

This entropy-balanced analysis of the MBSAQIP registry demonstrated an overall association between SLR and lower postoperative leakage and bleeding after RSG and LSG.

Characterization of trends in preoperative hemoglobin A1c testing prior to metabolic and bariatric surgery: a retrospective, observational study

BACKGROUND

Irrespective of baseline diabetes status, preoperative hemoglobin A1c (A1C) influences perioperative care in patients undergoing metabolic and bariatric surgery (MBS). Accordingly, the American Society of Metabolic and Bariatric Surgery (ASMBS) endorses that patients undergoing MBS should receive a preoperative A1C test. We aimed to assess the proportion of MBS patients who received a preoperative A1C test and determine whether baseline diabetes status influences receipt of a test.

METHODS

We queried the 2017 to 2022 MBSAQIP database for patients undergoing open, laparoscopic, or robotic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy. Using descriptive methods, we compared the clinical and demographic characteristics of patients who received a preoperative A1C test with patients who did not. We performed logistic regression analysis using diabetes status as a predictor variable and receipt of a test as the outcome, covarying for sociodemographic and clinical factors.

RESULTS

We identified 996,217 patients who underwent RYGB or sleeve gastrectomy between 2017 to 2022. The average age of the cohort was 43.8 years (SD = 11.9) and 81.0% were female. Overall, 45.7% received a preoperative A1C test. The proportion who was tested increased over the six-year study period, from 35.5% in 2017 to 56.0% in 2022. Compared to those who were not tested, patients who were tested were more likely to have several cardiopulmonary comorbidities, including COPD (1.4% vs 1.2%, p < 0.001), PE (1.4% vs 1.2%, p < 0.001), sleep apnea (39.3 vs. 36.4%, p < 0.001), HTN (47.1% vs 44.0%, p < 0.001), and MI (1.2% vs. 1.0%, p < 0.001), though the differences in proportions were small and may not be clinically significant. Compared to patients who did not have diabetes or had diabetes controlled by diet alone, patients with non-insulin dependent diabetes had 77% increased odds of receiving a A1C test (adjusted OR (aOR) 1.77, p < 0.001); insulin dependent patients had 113% increased odds (aOR 2.13, p < 0.001).

CONCLUSION

Despite society recommendations endorsing measurement of preoperative A1C prior to MBS, less than half of patients undergoing MBS between 2017 and 2022 received a preoperative A1C test. Additionally, there were differential patterns in testing based on diabetes status. Preoperative glycemic evaluation is an area for continued quality improvement.

Evaluating the incidence, risk factors and postoperative complications associated with leaks following duodenal switch procedures: an analysis of the MBSAQIP

BACKGROUND

Metabolic and Bariatric Surgery (MBS) is the most effective management for patients with obesity and weight-related medical conditions. Duodenal switch (DS) is a recent MBS procedure with increasing attention in recent years, however the risk of anastomotic or staple line leaks and the lack of efficient surgical expertise hinders the procedure from becoming fully adopted.

OBJECTIVES

To determine the 30-day predictors of leaks following DS and explore their association with other 30-day postoperative complications.

SETTING

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.

METHODS

Patients who underwent a primary biliopancreatic diversion with DS or single-anastomosis duodenoileostomy with sleeve procedure, categorized as DS, were assessed for 30-day leaks. A multivariable logistic regression was constructed to identify the predictors of leaks. The assessment of postoperative complications arising from leaks was also performed.

RESULTS

A total of 21,839 DS patients were included, of which 177 (.8%) experienced leaks within 30 postoperative days. The most significant predictor of leaks was steroid immunosuppressive use (adjusted odds ratio [aOR] = 3.01, 95% confidence interval [CI] [1.56-5.13], P < .001) and age, with each decade of life associated with a 26% increase in risk (aOR = 1.26, 95% CI [1.09-1.45], P = .001). Operative length was also associated with leaks, with every additional 30 minutes increasing the odds of a leak by 23% (aOR = 1.23, 95% CI [1.18-1.29], P < .001). The occurrence of leaks was correlated with postoperative septic shock (Crude Odds Ratio [COR] = 280.99 [152.60-517.39]) and unplanned intensive care unit (ICU) admissions (COR = 79.04 [56.99-109.59]). Additionally, mortality rates increased 17-fold with the incidence of leaks (COR = 17.64 [7.41-41.99]).

CONCLUSIONS

Leaks following DS are a serious postoperative complication with significant risk factors of steroid use, prolonged operative time and advanced age. Leaks are also associated with other severe complications, highlighting the need for early diagnosis and intervention along with additional studies to further validate our results.

From database to practice: the MBSAQIP in the surgical literature

BACKGROUND

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has been a game changer for metabolic and bariatric surgery (MBS), with continuous improvements in safety and outcomes throughout the years of its usage. It allows in-depth evaluations of MBS procedures, presenting practitioners and researchers with unparalleled opportunities for quality assessment, research and clinical advancement.

OBJECTIVES

To offer an updated overview of MBSAQIP-related publications.

SETTING

United States.

METHODS

PubMed was queried using keywords "MBSAQIP" and "Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program." Letters to editors, duplicates, commentaries, and retracted articles were excluded. Studies that mentioned MBSAQIP but did not use the data within were also excluded.

RESULTS

A total of 400 search items were returned as of August 2023. After exclusions, 289 studies were reviewed. Articles were published in a total of 28 unique journals, the majority of which were featured in Surgery for Obesity and Related Diseases (SOARD), with 114 articles (39.4%). Sixty-one articles were focused on creating predictive models or risk calculators, 58 on investigating the safety of procedures, and 52 on exploring complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were the 2 most commonly discussed procedures, at 80.3% and 80% respectively. Forty-three studies included patients who underwent robotic-assisted MBS.

CONCLUSIONS

The MBSAQIP is a valuable resource that has generated a wealth of studies in the literature. It has allowed for intense analysis of clinical issues and fostered a culture of safety and quality improvement. Participating surgeons must pledge commitment to extended follow-up periods to maximize its effectiveness.