SURGERY RISKS: The Latest Complication Rates Associated with Bariatric Surgery
By David Okolica, MD FACS FASMBS
How Safe is Bariatric Surgery Today?
Complication rates associated with laparoscopic bariatric surgery have been declining over the last several years for reasons which include improvement in bariatric programs, better training for surgeons and more appropriate patient selection. The complication rates vary slightly for different bariatric procedures, but overall, they are on par with other laparoscopic abdominal surgeries which are commonly performed, such as gallbladder and colon surgery. There have been dramatic advances in bariatric surgery since its inception which account for these changes, making bariatric surgery a very safe option for the morbidly obese population who have struggled to lose weight for many years.
A large drop in complication rates occurred over the last 15 years, as laparoscopic bariatric surgery developed and became the standard of care for the majority of bariatric operations. The incisions for surgery became smaller, the instrumentation became more technologically advanced, and the surgeons became more facile in performing the surgery, especially due to bariatric surgery training programs which developed across the country. For the most part, bariatric surgery is being done in accredited bariatric centers, which means that the institution has special designation to perform bariatric surgery. These accredited hospitals have appropriate multi-disciplinary providers to offer nutritional and behavioral counseling before surgery so patients avoid behaviors after surgery that could trigger complications and readmissions. In addition, these accredited facilities are staffed with bariatric surgeons who have the appropriate specialty training, as well as the advanced equipment needed to operate on morbidly obese patients. Complication rate statistics do vary based on the procedure being performed, the experience of the surgeon, and the facility, but the largest accredited facilities have published studies over the last several years that give the most current data about the overall complication rates of bariatric surgery.
For example, the laparoscopic sleeve gastrectomy, has been written about extensively in the surgical literature. The actual 30-day mortality of laparoscopic sleeve gastrectomy is 0.1% (1 in 1000) and 1-year mortality is 0.2% (1 in 500), which is comparable or lower than other general surgical procedures, such as gallbladder or colon surgery. The overall complication rate of the sleeve gastrectomy procedure is about 5%, which includes all complications, including surgical, medical and anesthesia-related issues, but the main surgical risks are staple-line leak (0.3% or about 1 in 300), bleeding (1% or 1 in 100), or stricture (narrowing) (0.5% or 1 in 200). The main medical complication which is seen more commonly in the bariatric population is pulmonary embolism and deep venous thrombosis (blood clots in leg veins which travel to the lungs). The overall rate of blood clots in the legs or lungs is 2-2.5%, but due to medical treatment, including anticoagulation, vein filters, and early ambulation, the chance of dying from these clots is 0.03% (1 in about 3000).
Overall, the complication rates from bariatric surgery are low when surgery is performed at an accredited center on properly selected patients. They have continued to drop over the last several years, even though all bariatric surgery has some inherent risk, much like other general surgical procedures. It is imperative that patients follow the bariatric providers’ instructions so that complications that may be effected by patient behavior can be avoided. Bariatric surgery has much to offer patients who suffer from morbid obesity and as complication rates decrease, patients can be more comfortable pursuing a surgical option for sustained weight loss with the hope of improvement in their overall heal