Top

Obesity Surgery

Published in:

Open Access 27-02-2024 | Chronic Inflammatory Bowel Disease | Original Contributions

Bariatric Surgery Outcomes in Patients with Inflammatory Bowel Disease in the United States: An Analysis of the Nationwide Readmissions Database

Authors: Noah C. Wilson, Danielle B. Dilsaver, Ryan W. Walters, Kalyana C. Nandipati

Published in: Obesity Surgery | Issue 4/2024

Abstract

Purpose

Bariatric surgery has been reported to produce durable weight loss in the management of obesity; sleeve gastrectomy (SG) is the most common bariatric procedure. Obesity is a common comorbidity of inflammatory bowel disease (IBD), and the impact of IBD on short-term SG outcomes has not been widely reported. This study assessed whether IBD was associated with adverse post-SG outcomes.

Materials and Methods

Hospitalizations of patients undergoing SG in the United States were identified using the 2010–2020 Nationwide Readmissions Database (NRD) and stratified by IBD diagnosis. The SG cohort was propensity-matched based on age, biological sex, body mass index (BMI), comorbid diabetes, hypertension, depression, chronic obstructive pulmonary disease, and discharge in quarter four. Primary aims were to compare in-hospital mortality, post-operative complications, and all-cause 90-day readmission between patients with and without IBD. Secondary outcomes were length of stay (LOS) and total hospital cost.

Results

A total of 2030 hospitalizations were matched. The odds of complication were 48% higher for hospitalizations of patients with IBD (11.1% vs. 7.8%; aOR 1.48, aOR 95% CI 1.10–2.00, p = .009). The most common complication was nausea (4.9% vs. 3.7%, p = .187). No statistically significant difference was observed for all-cause 90-day readmissions, LOS, or hospital cost.

Conclusion

Hospitalizations of patients with IBD who underwent SG experienced significantly higher post-operative complication rates. However, the similar lengths of stay and readmission rates compared to propensity-matched SG hospitalizations without IBD suggest many complications were minor. SG remains a safe weight loss procedure for patients suffering from IBD and obesity.

Graphical Abstract

Available only for authorised users

Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS data brief [Internet]. 2020;(360):1–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32487284. Accessed 8 Feb 2023.

Artham SM, Lavie CJ, Milani RV, Ventura HO. The obesity paradox: impact of obesity on the prevalence and prognosis of cardiovascular diseases. Postgraduate medicine [Internet]. 2008;120[2]:34–41. Available from: https://www.tandfonline.com/doi/abs/10.3810/pgm.2008.07.1788 .

Ward ZJ, Bleich SN, Long MW, Gortmaker SL. Association of body mass index with health care expenditures in the United States by age and sex. PLoS One [Internet]. 2021;16(3):e0247307. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33760880. Accessed 8 Feb 2023.

Xu F, Carlson SA, Liu Y, Greenlund KJ. Prevalence of inflammatory bowel disease among Medicare fee-for-service beneficiaries — United States, 2001−2018. MMWR Morb Mortal Wkly Rept [Internet]. 2021;70(19):698–701. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33983913. Accessed 3 Jul 2023.

Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories from 1990 to 2019: a systematic analysis based on the global burden of disease study 2019. BMJ Open [Internet]. 2023;13(3):e065186. Available from: https://doi.org/10.1136/bmjopen-2022-065186.

Flores A, Burstein E, Cipher DJ, Feagins LA. Obesity in inflammatory bowel disease: a marker of less severe disease. Dig Dis Sci [Internet]. 2015;60(8):2436–45. Available from: https://link.springer.com/article/10.1007/s10620-015-3629-5 .

Bertin B, Desreumaux P, Dubuquoy L. Obesity, visceral fat and Crohnʼs disease. Curr Opin Clin Nutr Metab Care [Internet]. 2010;13[5]:574–80. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20625283.

Karagiannides I, Pothoulakis C. Substance P, obesity, and gut inflammation. Curr Opin Endocrinol Diabetes Obes [Internet]. 2009;16[1]:47–52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19104238.

Braga Neto MB, Gregory MH, Ramos GP, Bazerbachi F, Bruining DH, Abu Dayyeh BK, Kushnir VM, Raffals LE, Ciorba MA, Loftus EV, Deepak P. Impact of bariatric surgery on the long-term disease course of inflammatory bowel disease. Inflamm Bowel Dis [Internet]. 2020;26(7):1089–97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31613968.

10.

Courcoulas AP, Yanovski SZ, Bonds D, Eggerman TL, Horlick M, Staten MA, Arterburn DE. Long-term outcomes of bariatric surgery: a national institutes of health symposium. JAMA Surg [Internet]. 2014;149(12):1323-9. Available from:https://doi.org/10.1001/jamasurg.2014.2440.

11.

Ozsoy Z, Demir E. Which bariatric procedure is the most popular in the world? A bibliometric comparison. Obes Surg [Internet]. 2018;28[8]:2339–52. Available from: https://link.springer.com/article/10.1007/s11695-018-3163-6 .

12.

Heshmati K, Lo T, Tavakkoli A, Sheu E. Short-term outcomes of inflammatory bowel disease after Roux-en-Y gastric bypass vs sleeve gastrectomy. J Am Coll Surg [Internet]. 2019;228(6):893,901.e1. Available from: https://doi.org/10.1016/j.jamcollsurg.2019.01.021.

13.

NRD Overview. Healthcare Cost and Utilization Project (HCUP). 2022. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nrdoverview.jsp. Accessed January 31, 2023.

14.

ICD-10-CM/PCS MS-DRG v36.0 Definitions Manual [Internet]. Available from: https://www.cms.gov/icd10m/version36-fullcode-cms/fullcode_cms/P0370.html. Accessed 18 Dec 2023.

15.

Elixhauser comorbidity software refined for ICD-10-CM healthcare cost and utilization project (HCUP). 2022. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/comorbidityicd10/comorbidity_icd10.jsp. Accessed February 1, 2023. [Internet] .

16.

United States Bureau of Labor Statistics. CPI inflation calculator. available at: https://www.bls.gov/data/inflation_calculator.htm. Accessed january 31, 2023. [Internet] .

17.

Rao JNK, Scott AJ. On simple adjustments to chi-square tests with sample survey data. Ann Stat [Internet]. 1987;15(1):385–97. Available from: http://www.jstor.org/stable/2241089. Accessed 18 Dec 2023.

18.

Holder-Murray J, Marsicovetere P, Holubar SD. Minimally invasive surgery for inflammatory bowel disease. Inflammatory Bowel Dis [Internet]. 2015;21(6):1443–58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25989341. Accessed 14 Sept 2023.

19.

Kopylov U, Ben‐Horin S, Zmora O, Eliakim R, Katz LH. Anti‐tumor necrosis factor and postoperative complications in Crohn’s disease: systematic review and meta‐analysis. Inflamm Bowel Diseases [Internet]. 2012;18(12):2404–13. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ibd.22954 .

20.

Xu X, Liu C, Feng B, Liu Z. Dysregulation of mucosal immune response in pathogenesis of inflammatory bowel disease. World J Gastroenterol: WJG [Internet]. 2014;20(12):3255–64. Available from: http://lib.cqvip.com/qk/84123X/201412/90888889504849524950485049.html.

21.

Reenaers C, de Roover A, Kohnen L, Nachury M, Simon M, Pourcher G, Trang-Poisson C, Rajca S, Msika S, Viennot S, Alttwegg R, Serrero M, Seksik P, Peyrin-Biroulet L, Picon L, Bourbao Tournois C, Gontier R, Gilletta C, Stefanescu C, Laharie D, Roblin X, Nahon S, Bouguen G, Carbonnel F, Attar A, Louis E, Coffin B. Bariatric surgery in patients with inflammatory bowel disease: a case-control study from the GETAID. Inflamm Bowel Dise [Internet]. 2022;28[8]:1198–206. Available from: https://search.proquest.com/docview/2581278539.

22.

Corbière L, Scanff A, Desfourneaux V, Merdrignac A, Ingels A, Thibault R, Bouguen G, Bergeat D. Outcomes of bariatric surgery in patients with inflammatory bowel disease from a French nationwide database. Br J Surg [Internet]. 2023;110[2]:251–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36448229. Accessed 19 Dec 2022.

23.

24.

Wallhuss A, Ottosson J, Cao Y, Andersson E, Bergemalm D, Eriksson C, Olén O, Szabo E, Stenberg E. Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: a nationwide registry-based cohort study. Surgery [Internet]. 2023;174(2):144-51.https://doi.org/10.1016/j.surg.2023.04.059.

25.

Park KT, Ehrlich OG, Allen JI, Meadows P, Szigethy EM, Henrichsen K, Kim SC, Lawton RC, Murphy SM, Regueiro M, Rubin DT, Engel-Nitz NM, Heller CA. The cost of inflammatory bowel disease: an initiative from the Crohn’s & Colitis Foundation. Inflamm Bowel Dise [Internet]. 2020;26(1):1–10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31112238. Accessed 8 Feb 2023.

26.

Nguyen NH, Ohno-Machado L, Sandborn WJ, Singh S. Obesity is independently associated with higher annual burden and costs of hospitalization in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol [Internet]. 201917(4):709,718.e7. Available from: https://doi.org/10.1016/j.cgh.2018.07.004.

27.

Coward S, Heitman SJ, Clement F, Hubbard J, Proulx M, Zimmer S, Panaccione R, Seow C, Leung Y, Datta I, Ghosh S, Myers RP, Swain M, Kaplan GG. Ulcerative colitis-associated hospitalization costs: a population-based study. Can J Gastroenterol Hepatol [Internet]. 2015;29(7):357–62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26079072. Accessed 14 Sept 2023.

28.

Principi M, Labarile N, Bianchi FP, Contaldo A, Tafuri S, Ierardi E, Di Leo A. The cost of inflammatory bowel disease management matches with clinical course: a single outpatient centre analysis. Int J Environ Res Public Health [Internet]. 2020;17(12):4549. Available from: https://search.proquest.com/docview/2418758708. Accessed 14 Sept 2023.

29.

Sebastian S, Segal JP, Hedin C, Pellino G, Kotze PG, Adamina M, Campmans-Kuijpers M, Davies J, de Vries AC, Casbas AG, El-Hussuna A, Juillerat P, Meade S, Millán M, Spinelli A. ECCO Topical review: roadmap to optimal peri-operative care in IBD. J Crohn's Colitis, [Internet] 2023;17(2):153–169. Available from:https://doi.org/10.1093/ecco-jcc/jjac129

Title: Bariatric Surgery Outcomes in Patients with Inflammatory Bowel Disease in the United States: An Analysis of the Nationwide Readmissions Database
Authors: Noah C. Wilson
Danielle B. Dilsaver
Ryan W. Walters
Kalyana C. Nandipati
Publication date: 27-02-2024
Publisher: Springer US
Keywords: Chronic Inflammatory Bowel Disease
Sleeve Gastrectomy
Bariatric Surgery
Bariatric Surgery
Ulcerative Colitis
Obesity
Obesity
Crohn's Disease
Published in: Obesity Surgery / Issue 4/2024
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07111-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bariatric Surgery Outcomes in Patients with Inflammatory Bowel Disease in the United States: An Analysis of the Nationwide Readmissions Database

Abstract

Purpose

Materials and Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

Graphical Abstract

Please log in to get access to this content

Other articles of this Issue 4/2024

Bariatric Surgery and New-Onset Substance Use Disorders: A Systematic review and Meta-analysis

Marginal Ulcer Incidence and the Population of Gastrin Producing G cells Retained in the Gastric Pouch after Roux-en-Y Gastric Bypass: Is There a Relationship?

Laparoscopic One Anastomosis Gastric Bypass for Class 3 Obesity in Patient with Situs Inversus Totalis

GLP-1 Receptor Agonists in Weight Loss and Bariatric Surgery: Balancing Efficacy and Gastrointestinal Adverse Events

Correlation Between Bariatric Surgery and the Risk of Multiple Myeloma: Results from an Evidence-Based Strategy

Convincing 10-Year Follow-up Results of the Banded Roux-en-Y Gastric Bypass