Predicting Risk for Serious Complications With Bariatric Surgery: Results from the Michigan Bariatric Surgery Collaborative
Abstract
OBJECTIVES: To develop a risk prediction model for serious complications after bariatric surgery. BACKGROUND: Despite 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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Among bariatric procedures, adjustable gastric banding has the lowest mortality rate (0.04%) and the lowest rate of serious complications (0.9%), while BPD/DS has the highest rate of serious complications (8%).
“Restrictive procedures such as adjustable gastric banding have the lowest mortality rate (0.04%) and the lowest rate of serious complications (0.9%), while BPD/DS has the highest rate of serious complications (8%), although the weight loss response is quite impressive [113].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [113]
The operative mortality rate after bariatric surgery is low relative to other major surgical procedures and ranges from 0.28% to 0.4%.
“Relative to other major surgical procedures, the operative mortality rate after bariatric surgery is low and it ranges from 0.28% to 0.4% [110-113].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [113]
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- Authors
- Finks, J. F., Kole, K. L., Yenumula, P. R., English, W. J., Krause, K. R., Carlin, A. M., Genaw, J. A., Banerjee, M., Birkmeyer, J. D., & Birkmeyer, N. J.
- Affiliations
- University of Michigan (US)
- St. John Macomb Oakland Hospital (US)
- Michigan State University (US)
- Marquette General Hospital (US)
- Beaumont Health (US)
- Corresponding author
- Finks, Jonathan F.
- Carlin, Arthur M.
- Genaw, Jeffrey A.
- Birkmeyer, John D.
- Birkmeyer, Nancy J.
- Venue
- Annals of Surgery
- Published
- 2011-10
- Volume
- 254
- Issue
- 4
- Pages
- 633-640
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2066677668
- Cited by
- 220
- References
- 35
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 8 · 2023: 8 · 2022: 12 · 2021: 8 · 2020: 14 · 2019: 21 · 2018: 11 · 2017: 17 · 2016: 23 · 2015: 21 · 2014: 31 · 2013: 24 · 2012: 11
- FWCI
- 21.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (1r01hs018050-01a1)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- bariatric surgery, postoperative complications, risk prediction model, risk factors, venous thromboembolism, mobility limitations, coronary artery disease, lung disease, smoking, duodenal switch, laparoscopic gastric bypass, sleeve gastrectomy, obesity, clinical registries, model validation, concordance index, calibration, 30-day morbidity
- MeSH terms
- Adult, Female, Humans, Male, Michigan, Middle Aged, Postoperative Complications, Severity of Illness Index, Risk Assessment, Bariatric Surgery
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