Bariatric Surgery and Inflammatory Bowel Disease: National Trends and Outcomes Associated with Procedural Sleeve Gastrectomy vs Historical Bariatric Surgery Among US Hospitalized Patients 2009–2020

• Authors: Joseph-Kevin Igwe, Stanford University; Phani Keerthi Surapaneni, Western Virginia University; Erin Cruz, Stanford University; Cedric Cole, Morehouse School of Medicine; Kingsley Kelechi Njoku, Emory University; Jisoo Kim, Texas Tech University; Ugo Alaribe, Caribbean Medical University; Kelechi Weze, Morehouse School of Medicine; Bilal Mohammed, Ascension Saint Vincent
• Journal Title: Obesity Surgery
• Volume: Volume 33, Number 11
• Publisher: Springer | 2023-10-09, Pages 3472-3486
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s11695-023-06833-7
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Bariatric surgery; Irritable bowel disease; Micronutrient deficiency

Abstract

Purpose The association between bariatric surgery and IBD-related inpatient outcomes is not well characterized. We report, analyze, and compare inpatient trends and outcomes among encounters with a history of bariatric surgery (Hx-MBS) compared to those receiving bariatric surgery during index admission (PR-MBS) admitted from 2009 to 2020. Methods Retrospective cohort design: the 2009–2020 National Inpatient Sample (NIS) databases were used to identify hospital encounters with patients aged ≥ 18 years with a history of MBS (Hx-MBS) or with procedure coding indicating MBS procedure (PR-MBS) according to International Classification of Diseases, Ninth (ICD-9-CM/ ICD-9-PCS) or Tenth Revision (ICD-10-CM/ICD-10-PCS) Clinical Modification/Procedure Coding System during index admission (ICD-9-CM: V4586; ICD-10-CM: Z9884; ICD-9-PR: 4382, 4389; ICD-10-PR: 0DB64Z3, 0DB63ZZ). Pearson χ2 analysis, analysis of variance, multivariable regression analyses, and propensity matching on independent variables were conducted to analyze significant associations between variables and for primary outcome inflammatory bowel disease-related admission, and secondary outcomes: diagnosis of nonalcoholic steatohepatitis, nonalcoholic fatty liver disease, or chronic mesenteric ischemia during admission. Results We identified 3,365,784 (76.20%) Hx-MBS hospitalizations and 1,050,900 hospitalizations with PR-MBS (23.80%). Propensity score matching analysis demonstrated significantly higher odds of inflammatory bowel disease, and chronic mesenteric ischemia for Hx-MBS compared to PR-MBS, and significantly lower odds of nonalcoholic steatohepatitis and nonalcoholic fatty liver disease for Hx-MBS compared to PR-MBS. Conclusion In our study, Hx-MBS was associated with significantly increased odds of inflammatory bowel disease and other GI pathologies compared to matched controls. The mechanism by which this occurs is unclear. Additional studies are needed to examine these findings.