Simultaneous conversion of gastric band to sleeve gastrectomy is associated with increased postoperative complications: an analysis of the American College of Surgeons National Surgical Quality Improvement Program.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity for the treatment of morbid obesity as gastric banding (BAND) has fallen out of favor. As a result, simultaneous conversion (CONV) of BAND to LSG is commonly performed. We hypothesized that CONV is associated with higher 30-day risk-adjusted serious morbidity.

METHODS: Preoperative characteristics and 30-day outcomes from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files 2010-2014 were selected for patients who underwent LSG. Patients undergoing CONV were identified. Descriptive comparisons were performed using Chi-square and Wilcoxon rank-sum tests as appropriate. Multivariate logistic regression was performed to assess the association between CONV and a composite measure of 30-day serious morbidity and mortality.

RESULTS: Overall, 35,307 patients met criteria for inclusion, of which 943 (2.7%) underwent CONV. The median age of patients undergoing CONV was higher (46 vs 44 years, p < 0.001) and a greater percentage of CONV patients was female (84.8 vs 77.9%, p < 0.001) than LSG patients. CONV patients had lower rates of common comorbidities, including diabetes (14.9 vs 23.1%, p < 0.001), hypertension (41.9 vs 48.6%, p < 0.001), and tobacco use (7.2 vs 9.8%, p < 0.001), as well as lower median BMI (41 vs 44, p < 0.001). Individual unadjusted outcomes of serious 30-day complications were similar between both groups, as was a composite measure of serious morbidity (CONV 4.3% vs LSG 3.6%, p = 0.1). However, after controlling for demographics, comorbidities, and concurrent band removal, CONV was associated with increased odds of serious 30-day morbidity (1.44, 95% CI 1.03-1.97) (c-statistic: 0.60).

CONCLUSIONS: Serious morbidity following LSG is uncommon; however, CONV is associated with a modest increase in risk-adjusted adverse 30-day outcomes. Patients being evaluated for CONV should be counseled about the added risks versus LSG alone. Further research is warranted to identify whether the incremental risks of CONV may be modifiable.