Trends of Drain Placement During Revisional Bariatric Surgeries and Its Association with 30-Day Morbidity: An MBSAQIP Analysis of 64,495 Patients

TL;DR

This study examines drain placement trends in revisional bariatric surgeries and finds that drain use is decreasing but still associated with higher 30-day complication rates.

Contribution

The study provides new insights into drain placement trends and their association with postoperative complications in revisional bariatric surgeries using a large MBSAQIP database.

Findings

Drain placement decreased from 19.1% in 2020 to 14.4% in 2022.

Drain placement was independently associated with increased risk of complications like hemorrhage, infection, and reoperation.

Abstract

Bariatric surgery remains the most effective long-term solution for weight loss, and as its popularity rises, there are an increasing number of patients who may require revision of their previous procedure or conversion to another procedure for additional weight loss or to manage side effects of the surgery. These surgeries tend to be higher risk and drain placement may play a role in improving overall short-term complications by catching or mitigating the impact of complications. In our study, which assessed over 60,000 patients from MBSAQIP centers, drain placement was common but decreasing year by year. It was associated with higher risk of 30-day complications, even in context of surgery type, duration, and other patient factors. Anastomotic procedures and more comorbid patients were usually more likely to have drain placement. Though firm conclusions about the impact of drains on revisional or conversional bariatric surgery are difficult to make, given the lack of granular operative or intraoperative decision-making data, surgeons should be judicious when it comes to drain placement.

Background: Drains are often placed during bariatric procedures; however, their use in conversional or revisional bariatric surgery (CRBS) has not been thoroughly explored. Our study sought to identify the frequency of drain placement in CRBS, and characterize factors associated with drain placement and their influence on 30-day serious complications. Methods: Patients undergoing CRBS between 2020 and 2022 were included from the MBSAQIP database. Patients were placed into drain placed (DP) versus no drain (ND) cohorts and baseline characteristics and complication rate were compared. Multivariable logistic regression models were used to identify independent predictors of drain placement and complications. Results: of 64,495 included patients, drains were placed in 19.1% in 2020; this was down to 14.4% in 2022. Drain placement was associated with increased risk of multiple complications such as hemorrhage, readmission, surgical site infection, and gastrointestinal bleeding. On multivariate analysis, drain placement was an independent predictor of serious complications (aOR 1.45, p < 0.001), anastomotic leak (aOR 2.25, p < 0.001), organ space infection (aOR 2.12, p < 0.001), and reoperation (aOR 1.37, p < 0.001), as well as excess LOS (aOR 2.06, p < 0.001). Predictors of drain placement include older age, higher BMI, smoking status, history of venous thromboembolism, and procedural factors, such as undergoing non-sleeve revisional surgery or having an intraoperative leak test. Conclusions: Drain placement during CRBS surgical procedures is common and more likely in higher risk patients and anastomotic revisional procedures. Though the reasons for drain placement were not available, these data suggest that surgeons should be judicious in selecting patients for drain placement due to its association with increased LOS and postoperative morbidity in CRBS.