Predicting Risk for Serious Complications With Bariatric Surgery: Results from the Michigan Bariatric Surgery Collaborative

Objectives:To develop a risk prediction model for serious complications after bariatric surgery. BackgroundDespite evidence for improved safety with bariatric surgery, serious complications remain a concern for patients, providers and payers. There is little population-level data on which risk factors can be used to identify patients at high risk for major morbidity. Methods:The Michigan Bariatric Surgery Collaborative is a statewide consortium of hospitals and surgeons, which maintains an externally-audited prospective clinical registry. We analyzed data from 25,469 patients undergoing bariatric surgery between June 2006 and December 2010. Significant risk factors on univariable analysis were entered into a multivariable logistic regression model to identify factors associated with serious complications (life threatening and/or associated with lasting disability) within 30 days of surgery. Bootstrap resampling was performed to obtain bias-corrected confidence intervals and c-statistic. Results:Overall, 644 patients (2.5%) experienced a serious complication. Significant risk factors (P < 0.05) included: prior VTE (odds ratio [OR] 1.90, confidence interval [CI] 1.41–2.54); mobility limitations (OR 1.61, CI 1.23–2.13); coronary artery disease (OR 1.53, CI 1.17–2.02); age over 50 (OR 1.38, CI 1.18–1.61); pulmonary disease (OR 1.37, CI 1.15–1.64); male gender (OR 1.26, CI 1.06–1.50); smoking history (OR 1.20, CI 1.02–1.40); and procedure type (reference lap band): duodenal switch (OR 9.68, CI 6.05–15.49); laparoscopic gastric bypass (OR 3.58, CI 2.79–4.64); open gastric bypass (OR 3.51, CI 2.38–5.22); sleeve gastrectomy (OR 2.46, CI 1.73–3.50). The c-statistic was 0.68 (bias-corrected to 0.66) and the model was well-calibrated across deciles of predicted risk. Conclusions:We have developed and validated a population-based risk scoring system for serious complications after bariatric surgery. We expect that this scoring system will improve the process of informed consent, facilitate the selection of procedures for high-risk patients, and allow for better risk stratification across studies of bariatric surgery.

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