Impact of functional status on 30-day resource utilization and organ system complications following index bariatric surgery: a cohort study

Abstract

Background: Bariatric surgical procedures carry an appreciable risk profile despite their elective nature. Identified risk factors for procedural complications are often limited to medical comorbidities. This study assesses the impact of functional status on resource utilization and organ system complications following bariatric surgery. Materials and methods: This retrospective cohort study analyzed patients undergoing elective, index bariatric surgery from American College of Surgeons National Surgical Quality Improvement Program participating hospitals from 2015 to 2019 (n=65 627). The primary independent variable was functional status. The primary outcome was unplanned resource utilization. Secondary outcomes included composite organ system complications and mortality. The impact of functional status was first investigated with univariate analyses. Survival and multivariate analyses were then performed on select complications with clinically and statistically significant incidence in the dependent cohort. Results: On univariate analysis, dependent functional status was associated with unplanned resource utilization [12.1% (27/223) vs. 4.1% (2661/65 404)]; relative risk, 2.98 (95% CI, 2.09–4.25); P < 0.001] and haematologic/infectious complications [6.7% (15/223) vs. 2.4% (1540/65 404); relative risk, 2.86 (95% CI, 1.75–4.67); P < 0.001]. Survival analysis demonstrated a significantly shorter time to both events in patients with dependent functional status (P < 0.001). On multivariate analysis, dependent functional status was an independent predictor of unplanned resource utilization[adjusted odds ratio 2.17 (95% CI, 1.27–3.50); P = 0.003; model c-statistic, 0.572]) and haematologic/infectious complications [adjusted odds ratio, 2.20 ([95% CI, 1.14–3.86); P = 0.011; model c-statistic, 0.579]. Conclusion: Patients with dependent functional status are at an elevated risk of unplanned resource utilization and haematologic/infectious complications following index bariatric surgery. The increased risk cannot be explained by medical comorbidities alone.