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Obesity Surgery

, Volume 29, Issue 10, pp 3309–3315 | Cite as

Effects of Chronic Corticosteroid and Immunosuppressant Use in Patients Undergoing Bariatric Surgery

  • Joshua HeflerEmail author
  • Jerry Dang
  • Aryan Modasi
  • Noah Switzer
  • Daniel W. Birch
  • Shahzeer Karmali
Original Contributions
  • 91 Downloads

Abstract

Background

Chronic immunosuppression can put surgical patients at additional risk for complications, particularly infection. This is not a contraindication for patients undergoing bariatric surgery. However, with the increasing prevalence of bariatric surgery, it is important to characterize the additional risks for immunosuppressed patients.

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry was used to identify immunosuppressed patients who had undergone bariatric surgery. Patients undergoing primary bariatric surgery (laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy) at an accredited institution between 2015 and 2017 were included. A multivariable regression analysis was performed, controlling for age, sex, procedure, and several other comorbidities. Overall 30-day incidence of major complications was the primary outcome. A secondary analysis compared outcomes amongst immunosuppressed patients by procedure type using a propensity-matched analysis. Propensity matching was performed based on preoperative comorbidities and bariatric procedure.

Results

A total of 430,936 patients were included in the study. Of these, 7214 (1.7%) were chronically immunosuppressed. Our multivariable regression analysis found statistically higher odds of 30-day major complications (OR 1.39, 95% CI 1.25–1.55; p < 0.001), bleed (OR 1.49, 95% CI 1.24–1.80; p < 0.001) and anastomotic leak (OR 1.38, 95% CI 1.02–1.87; p = 0.037) amongst immunosuppressed patients. However, there was no difference between 30-day mortality (OR 1.15, 95% CI 0.64–2.07; p = 0.644). Our secondary analysis found higher rates of 30-day major complications for immunosuppressed patients undergoing gastric bypass (9.6% vs. 5.0%; p < 0.001).

Conclusion

Immunosuppressed patients are at higher risk of major complications when undergoing bariatric surgery, especially gastric bypass.

Keywords

Immunosuppression Steroids 30-day complications Roux-en-Y gastric bypass Sleeve gastrectomy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

For this type of study, formal consent was not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Mackenzie Health Sciences CentreEdmontonCanada
  3. 3.Wexner Medical CenterThe Ohio State UniversityColumbusUSA

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