PREDICTIVE FACTORS FOR POSTOPERATIVE COMPLICATIONS IN BARIATRIC SURGERY.

Abstract

Bariatric surgery is the most effective long-term treatment for morbid obesity, but it is associated with a risk of significant postoperative complications. This study aimed to identify and validate predictive factors for early postoperative complications following bariatric surgery. A retrospective cohort study was conducted on 850 consecutive patients who underwent primary bariatric procedures, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), at our institution between January 2020 and December 2022. Data collected included patient demographics, preoperative comorbidities (e.g., diabetes, hypertension, obstructive sleep apnea), BMI, operative details, and length of hospital stay. The primary outcome was the occurrence of any major postoperative complication within 30 days, defined by the Clavien-Dindo classification grade III or higher. Univariate analysis revealed that a higher preoperative BMI (p<0.001), the presence of obstructive sleep apnea (p=0.015), and a history of previous abdominal surgery (p=0.038) were significantly associated with an increased risk of complications. Multivariable logistic regression confirmed that a preoperative BMI >50 kg/m2 (adjusted odds ratio [OR] 3.2, 95% confidence interval [CI] 1.8-5.6) and obstructive sleep apnea (adjusted OR 2.5, 95% CI 1.3-4.7) were independent predictors of major complications. The type of procedure also played a role, with RYGB having a higher complication rate than SG (adjusted OR 1.8, 95% CI 1.1-3.0). Based on these findings, a predictive model was developed to stratify patients into low- and high-risk groups. This model showed good discriminative ability with an area under the curve (AUC) of 0.78. This study provides a valuable tool for preoperative risk assessment and patient counseling, enabling surgeons to implement targeted perioperative strategies to mitigate the risk of complications in high-risk patients.