The Rate of Bariatric Surgery and Its Inpatient Complications in Morbidly Obese Patients With Inflammatory Bowel Disease

Introduction: The prevalence of morbid obesity in patients with inflammatory bowel disease (IBD) is increasing, but there is limited data surrounding the frequency and types of post-operative complications for bariatric surgeries (BS) in this population, contributing to procedural hesitancy. Methods: We conducted a retrospective analysis using data from the National Inpatient Sample to identify adult patients who were hospitalized for BS between 2016 and 2018. BS, IBD and inpatient complications were identified based on ICD-10 codes (Table 1). The rates and types of BS were compared between those with and without IBD. The rates of inpatient complications and having at least one complication were compared, and where able, multivariable logistic regressions controlling for patient and hospital characteristics were performed. Results: Among 90,879,561 adult hospitalizations from 2016-2018, 7,801,862 (8.6%) involved patients with morbid obesity and no IBD, and 514,650 (6.6%) underwent BS. 55,615 (7.1%) patients had morbid obesity and IBD, and 1,435 underwent BS (2.6%). Compared to those without, patients with IBD had similar rates of open Roux-en-Y gastric bypass (ORYGB) (∼1%; n=20; P=0.328) and laparoscopic adjustable gastric band (LAGB) (< 1%; n=10; P=0.206), a significantly lower rate of laparoscopic Roux-en-Y gastric bypass (LRYGB) (14% vs 27%; n=205; P< 0.001), and a significantly higher rate of sleeve gastrectomy (SG) (84% vs 72%; n=1,200; P< 0.001). Comparing those with and without IBD undergoing LRYGB, those with IBD had significantly higher rates of at least one inpatient complication (7.32% vs 0.75%; aOR: 7.1; CI: 1.8-27.8), wound dehiscence (2.44% vs 0.1%; aOR: 22.9; CI: 3.1-170.3), and peritonitis (4.88% vs. 0.19%; aOR: 25.3; CI: 6.0-105.8). Similar outcomes were not seen for SG. SG also had 5 cases of pneumonia compared to 0 for LRYGB. For both LRYGB and SG, the rates of other complications were lower when comparing those with IBD to those without (Table 1). Conclusion: Our study indicates that the of rate SG complications in patients with IBD is low, and that the decision to preferentially choose SG appears supported by the lower rates of complications seen, driven by a reduction in wound dehiscence and peritonitis. Although the number of cases limited our ability to statistically detect differences in some outcomes, we speculate that the incidence of major inpatient complications associated with BS is low given we found no cases of many major adverse outcomes. Table 1. - Total types of bariatric surgery and complications of those with and without IBD from 2016 to 2018 IBD (n = 1,435) No IBD (n = 515,450) Procedures, n (%) ORYGB (n = 4,435) 20 1.4% 4,415 0.9% LRYGB (n = 139,900) 205 14.3% 139,695 27.1% LGB (n = 1,520) 10 0.7% 1,510 0.3% SG (n = 371,310) 1,200 83.6% 370,110 71.8% Complications (non-bold = LRYGB; bold = SG), n (%) Death 0 0.00% 64 0.05% 0 0.00% 75 0.02% Any complication 15 7.32% 1,045 0.75% 5 0.42% 975 0.26% Wound dehiscence 5 2.44% 145 0.10% 0 0.00% 60 0.02% Pneumonia 0 0.00% 375 0.27% 5 0.42% 290 0.08% Myocardial infarction 0 0.00% 40 0.03% 0 0.00% 115 0.03% Neurovascular ischemia 0 0.00% 25 0.02% 0 0.00% 35 0.01% Pulmonary embolism 0 0.00% 65 0.05% 0 0.00% 100 0.03% Deep vein thrombosis 0 0.00% 155 0.11% 0 0.00% 250 0.07% Infection related to procedure 0 0.00% 155 0.11% 0 0.00% 105 0.03% Peritonitis 10 4.88% 270 0.19% 0 0.00% 170 0.05%