Hospital admissions increase after gastric bypass surgery

Last Updated: 2017-01-05

By Will Boggs MD

NEW YORK (Reuters Health) - Hospital admission rates more than triple after Roux-en-Y gastric bypass surgery (RYGB), researchers from Denmark report.

"The very low short-term complication rate after gastric bypass with only 3.3% readmission within 30 days together with our recent findings of a very low operative mortality (only 0.04%) are good news for patients planning to undergo a gastric bypass operation," Dr. Sigrid Bjerge Gribsholt from Aarhus University Hospital in Aarhus, Denmark, told Reuters Health by email. "The problem with this operation is, however, the more long-term complications."

Complications after RYGB can include abdominal pain, anemia, neurologic conditions, kidney stones, gallstones, and self-harm emergencies, but little is known about the hospital admission rates before and after RYGB.

Dr. Gribsholt's team used data from the Danish National Health Care System and the Danish Civil Registration System to compare the rate of acute inpatient hospital admissions before and after RYGB surgery of more than 9,900 patients with that of some 247,000 age- and sex-matched individuals from the general population without RYGB.

During a median follow-up of 4.2 years, 23.9% of RYGB patients were admitted for surgical complications, the researchers report in Annals of Surgery, online December 16.

Before surgery, patients who subsequently underwent RYGB were 95% more likely to require hospital admission compared with controls (11.5 vs. 5.9 per 100 person-years). After RYGB, the relative risk increased to 3.38 (24.9 vs. 7.1 per 100 person-years). Both differences were statistically significant.

Among RYGB patients, admissions due to chronic pulmonary disease, cardiovascular diseases, and diabetes declined significantly after surgery. But there were substantial increases in relative admission rates for gallstones, kidney disease, alcohol abuse, hypoglycemia, self-harm, anemia, and osteoporosis.

After matching RYGB patients and controls on comorbidities and obesity, those who underwent RYGB surgery had admission rates 19% below controls before surgery but 42% higher than controls after surgery.

"The increased overall rate of hospital admissions, including those for abdominal complications (abdominal pain), anemia, alcohol abuse, and self-harm, is of concern," Dr. Gribsholt said. "Enhanced focus on these conditions after RYGB surgery is needed in order to diagnose these complications very early, which in most conditions will greatly improve their outcome."

"Some of the nutritional complications, such as anemia, dumping and hypoglycemia, may present with rather unspecific symptoms that may easily be overlooked as a complication after gastric bypass by, e.g., the GPs," she said. "Thus, more education of the GPs may help to diagnose these complications at an earlier stage which will help the patients since these complications are generally treatable rather easily."

"Concerning the dominating surgically related complications, alternative methods to the classic gastric bypass would be advisable for the future," Dr. Gribsholt concluded. "Thus, focused research to develop new surgical procedures with fewer complications should be of high priority."

Dr. Junaid A. Bhatti from the University of Toronto and Institute for Clinical Evaluative Sciences in Canada, who recently examined emergency care use after weight loss surgery, told Reuters Health by email, "All the findings of the study are interesting and are consistent with my previous work published in JAMA Surgery and American Journal of Emergency Medicine showing an increasing risk for emergency visits specific to certain causes including self-harm and mental health problems."

"These findings highlight the need of long-term compliance with dietary recommendations following surgery in bariatric surgery patients," he said.

Dr. Bhatti noted that the authors encourage screening for mental health problems after surgery. "Most programs have intensive pre-screening procedures, yet studies are consistently showing that a significant proportion of patients screened for surgery demonstrate mental health effects following surgery," he said.

"Long-term consequences of obesity and their treatments remain largely unknown, and funding must be made available to evaluate and refine existing treatments of obesity, including bariatric surgery," Dr. Bhatti concluded. "Lastly, mechanisms of many of the known side effects need to be clarified, e.g., why addiction increases, why self-harm increases following bariatric surgery."

SOURCE: http://bit.ly/2iecYbw

Ann Surg 2016.