Modelling of predictors associated with surgical failure after bariatric surgery for 14,404 patients of the national German StuDoQ register

Background Surgical weight loss failure after bariatric surgery is most frequently defined as total weight loss<20% and/or excess weight loss (EWL)<50%. Exposures associated with surgical outcome after bariatric surgery have shifted into focus over the last decade. In this comparative effectiveness study, we describe data of the German bariatric surgery registry (StuDoQ|MBE), compare distribution of covariates in successful versus unsuccessful cases and provide a multivariate model of predictors of surgical failure.

Materials and methods This national cohort study of StuDoQ|MBE includes all cases between 2015 and 2019 with at least 1 year follow up after primary sleeve gastrectomy (SG), Roux-Y gastric bypass (RYGB) or One-anastomosis gastric bypass (OAGB) (n=14404). Patient characteristics including age at operation, gender, age at diagnosis of obesity, comorbidities, parental predisposition, as well as type of surgery are analyzed for postoperative TWL. We estimate univariate associations with the Fishers-Test and Mann-Whitney U test and fit a multivariate logistic regression model to identify independent predictors of surgical failure.

Results 26.1% of patients were male (n=3756) and 73.9% female (n=10648), with mean age of 44 years. Mean preoperative BMI was 49.1 kg/m². 27.3% (n=3896) of cases were diagnosed with type 2 diabetes (T2D) and 65.9% (n=7233) from arterial hypertension (aHT). Mean age at diagnosis of obesity was 16 years, with a mean duration of obesity of 27.3 years. SG is the most frequently performed procedure (47.2%, n= 6805) compared to RYGB (39.7%, n=5722) and OAGB (13.1%, n=1877). 89.7% (n=12927) of patients reported parental predisposition to obesity (maternal: 58.8%, paternal: 45.7%)

Mean TWL at 1 year was 31.4% and at 3 years 31.3%. Overall 9.3% of patients recorded surgical failure after 1 year of surgery and 1.5% after 3 years. After SG 11.8% of patients showed TWL<20%, compared to 7% and 7% after RYGB and OAGB respectively. In univariate analysis, SG, preoperative weight loss, age, preoperative BMI, male gender, T2D and aHT were associated with failure of adequate weight loss (TWL<20%). Multivariate analysis showed robust and highly significant association of age>50, lower preoperative BMI, lack of maternal predisposition, preoperative weight loss (>0 kg), SG, T2D, and aHT with weight loss failure after BMS (p<0.001).

Conclusion These data of the StuDoQ|MBE cohort are representative of current procedure selection and effectiveness in certified German surgical centers. 9.3% of patients fail to meet current target criteria of surgical success. Lower preoperative BMI, older age at operation, preoperative weight loss, SG and T2D are independently associated with poor outcome in terms of total weight loss.

 

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Artikel online veröffentlicht:
19. August 2022