Postoperative pulmonary complications in patients with chronic obstructive pulmonary disease undergoing primary laparoscopic bariatric surgery: an MBSAQIP analysis

Roberto J Valera; Mauricio Sarmiento Cobos; Francisco X Franco; Bakhtawar Mushtaq; Lisandro Montorfano; Emanuele Lo Menzo; Samuel Szomstein; Raul J Rosenthal

doi:10.1016/j.soard.2024.08.032

Postoperative pulmonary complications in patients with chronic obstructive pulmonary disease undergoing primary laparoscopic bariatric surgery: an MBSAQIP analysis

Surg Obes Relat Dis. 2024 Sep 2:S1550-7289(24)00793-7. doi: 10.1016/j.soard.2024.08.032. Online ahead of print.

Authors

Roberto J Valera¹, Mauricio Sarmiento Cobos¹, Francisco X Franco², Bakhtawar Mushtaq³, Lisandro Montorfano¹, Emanuele Lo Menzo¹, Samuel Szomstein¹, Raul J Rosenthal⁴

Affiliations

¹ Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida.
² Department of Heart, Vascular and Thoracic Surgery, Cleveland Clinic, Weston, Florida.
³ Department of General Surgery, Jefferson Abington Health, Abington, Pennsylvania.
⁴ Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic, Weston, Florida. Electronic address: ROSENTR@CCF.ORG.

PMID: 39419715
DOI: 10.1016/j.soard.2024.08.032

Abstract

Background: Recent research has shown beneficial effects of bariatric surgery (BaS) on the risk of developing acute exacerbations of chronic obstructive pulmonary disease (COPD). However, this patient population may be at increased risk of complications, especially postoperative pulmonary complications (PPC).

Objectives: To analyze the incidence of PPC in patients with COPD undergoing BaS.

Setting: Academic Hospital, United States.

Methods: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass during 2015-2019. The primary outcome of the study was any PPC, defined as a composite variable including postoperative pneumonia, mechanical ventilation >48 hours and unplanned endotracheal intubation. A univariate analysis was performed to compare patients with and without COPD, and a multivariate logistic regression was performed to adjust for confounders. A subgroup analysis was performed to compare endpoints in patients with COPD with or without home oxygen requirements.

Results: A total of 752,722 patients were included in our analysis (laparoscopic sleeve gastrectomy = 73.2%, Roux-en-Y gastric bypass = 26.8%). PPC occurred in 2390 patients, 0.3% without COPD versus 1.3% with COPD (P < .001). Multivariable analysis confirmed that COPD independently increases the risk of PPC (OR = 1.7, CI = 1.4-2.1). Subgroup analysis showed that patients who are oxygen dependent had a much higher risk for PPC (2.4% versus 1.1%, P < .001).

Conclusion: PPC are higher among patients with obesity and concomitant COPD. Oxygen dependency confers an even higher complication rate. The risk and benefits of BaS in this population must be carefully addressed.

Keywords: Bariatric surgery; Chronic obstructive pulmonary disease; Endotracheal intubation; Mechanical ventilation; Obesity; Pneumonia.