Farah Husain

Risk factors for early postoperative complications after bariatric surgery

Purpose Vertical sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are currently the most common bariatric procedures. Although the safety of these operations has markedly improved, there continues to be a certain rate of complications. Such adverse events can have a significant deleterious effect on the outcome of these procedures and represent a costly burden on patients and society at large. A better understanding of these complications and their predictive factors may help ameliorate and optimize outcomes. Methods Seven hundred seventy-two consecutive patients who underwent SG or RYGB for morbid obesity between January 2011 and October 2015, in the Division of Bariatric Surgery at a tertiary institution, were included through retrospective review of the medical database. The complications were categorized and evaluated according to severity using the Clavien-Dindo classification system. Significant risk factors were evaluated by binary logistic regression to identify independent predictors and analyzed to identify their relationship with the type of complication. Results Independent predictors of severe complication after these procedures included male gender, open and revisional surgery, hypertension, and hypoalbuminemia. Hypoalbuminemia had significant associations with occurrence of deep surgical site infection and leak. Open surgery had significant associations with occurrence of superficial and deep surgical site infection and respiratory complications. Independent predictors of severe complication after laparoscopic primary RYGB included previous abdominal surgery. Previous abdominal surgery had significant associations with deep surgical site infection and leak. Conclusion Recognition and optimization of these risk factors would be valuable in operative risk prediction before bariatric surgery.

Bariatric Tourism: Bidirectional and in the United States

Bariatric tourism is defined as the travel of an individual to another region to pursue a bariatric operation. This chapter will focus on bariatric tourism related to the United States. As such, bariatric tourism can be considered as outbound (outside the United States), inbound (into the United States), or intrabound (within the United States). Bariatric tourism presents a complex clinical, societal, and international issue that is multifaceted both at the patient level and at the population level. The decision for a patient to pursue bariatric care outside of their healthcare region can have multiple implications for their own safety as well as the well-being of the populations they visit. In addition, the management of the bariatric meditourist poses a unique clinical challenge for surgeons who are tasked with managing complications. We present the known literature on bariatric tourism, including the estimated scope of the issue, current guidelines, the outcomes and international standards of care, cost considerations, and ethical issues.