Major early complications following Bariatric Surgery: a systematic review and meta-analysis

This systematic review and meta-analysis studied major surgical complications, including pulmonary embolism (PE), myocardial infarction (MI), and leak, resulting from different bariatric surgery procedures, using recently published data and appropriate meta-analysis techniques. Surgeries considered were Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Literature searches of PubMed, Embase, Scopus, and the Cochrane Library databases between 2003 and September 2014 were performed. Articles were screened for exclusion and inclusion criteria before data extraction. Quality of evidence was assessed and each article was rated for quality. Post-surgery complication rates of PE, MI, and leak were stratified by time points (≤30 day and >30 day) and synthesized by Bayesian random-effects meta-analyses. In cases in which both randomized control trials (RCTs) and observational studies (OBSs) were available, RCTs and OBSs were analyzed separately. Our study included 61 articles (60 OBSs, 1 RCT) and 108,396 patients with a mean age of 44.3 years and mean pre-surgery body mass index (BMI) of 46.5 kg/m2. Only one article recorded a leak following RYGB at ≥30 days, reporting 2 in 218 patients. The ≤30 day mean rate of complications and the 95% credible intervals (in brackets) for OBSs are presented. The leak rate for RYGB was 0.91% [0.56%, 1.35%] and for SG was 0.72% [0.01%, 2.54%]. The MI rate for RYGB was 0.06% [0.02%, 0.15%] and higher for AGB 1.05% [0%, 2.68%]. Incidence of PE for all procedures was 0.35% [0.14%, 0.74%], with AGB having the lowest rate (0.11%), followed by SG (0.54%) and RYGB (0.69%). This study suggests that the risk of PE, MI, and leak following bariatric surgery is low. However, these are serious, life-threatening adverse events with non-negligible coincidence whose risk should be effectively communicated to patients when surgical treatment is considered.