There is an increasing volume of revisional bariatric surgery. Data indicates these surgeries can result in improved weight loss and resolution of co-morbidities. However, multiple studies are showing worst outcomes in revisional surgery including increased complication rates and longer hospital stays. As an institution we have a high volume of revision surgery which is handled both laparoscopically and robotically.
A retrospective review of a prospective database of 441 patients who had undergone bariatric surgery at Baylor University Medical Center by a single experienced bariatric surgeon from 2016 to 2018 were included in this study. The patients were divided into those undergoing initial versus revisional bariatric surgery. The primary outcomes were length of stay, readmissions, and complication rates comparing initial to revision surgeries. Secondary outcomes included comparing similar outcomes in robotic versus laparoscopic revision surgeries.
Almost a quarter of the 441 bariatric surgeries were revisions. Patient undergoing revisions had a significantly longer hospital stay (3.9 vs. 1.4 days), longer duration of surgery (160 vs. 103.8 minutes), and a higher 30 day readmission rate (12.8% vs. 5.4%). Robotic revisions had a longer operative time than laparoscopic revisions by an average of 97 minutes, but a decreased readmission rate related to bariatric-specific problems (17.5% vs. 5.8%).
Revisional bariatric surgeries had significantly longer lengths of stay, longer surgeries, and a higher readmission rate. There is increasing evidence indicating revision surgery has a unique set of outcomes, and standards need to be set accordingly for expected outcomes.