Thirty-day morbidity and mortality of bariatric and metabolic surgery in patients with type 2 diabetes mellitus: A subset analysis of the GENEVA cohort study

Rishi Singhal; Victor Roth Cardoso; Christian Ludwig; Jonathan Super; Yashasvi Rajeev; Gavin Rudge; Georgios V Gkoutos; Kamal Mahawar; GENEVA collaborators

doi:10.4103/jbs.jbs_1_21

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ORIGINAL ARTICLE

Year : 2022 \| Volume : 1 \| Issue : 1 \| Page : 34-41

Thirty-day morbidity and mortality of bariatric and metabolic surgery in patients with type 2 diabetes mellitus: A subset analysis of the GENEVA cohort study Rishi Singhal¹, Victor Roth Cardoso², Christian Ludwig³, Jonathan Super⁴, Yashasvi Rajeev⁵, Gavin Rudge⁶, Georgios V Gkoutos⁷, Kamal Mahawar⁸, GENEVA collaborators⁹ ¹ Department of General Surgery, Upper GI Unit, University Hospital Birmingham NHS Foundation Trust, West Midlands, United Kingdom ² Institute of Cancer and Genomic Sciences, University of Birmingham, West Midlands; Health Data Research UK Midlands, Birmingham, United Kingdom ³ Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom ⁴ Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Royal Tunbridge Wells, Harrow, London, United Kingdom ⁵ Department of Surgery, London Northwest University Healthcare NHS Trust, Harrow, London, United Kingdom ⁶ Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, United Kingdom ⁷ Institute of Cancer and Genomic Sciences, University of Birmingham, West Midlands; Health Data Research UK Midlands; NIHR Biomedical Research Centre; NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, United Kingdom ⁸ Department of General Surgery, Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, United Kingdom Correspondence Address: Rishi Singhal Department of General Surgery, Upper GI Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham United Kingdom Source of Support: None, Conflict of Interest: None DOI: 10.4103/jbs.jbs_1_21

Introduction: There is a paucity of data in the scientific literature on the morbidity and mortality of bariatric and metabolic surgery (BMS) in individuals suffering from Type 2 diabetes mellitus (T2D). The current study is a secondary analysis of the GENEVA dataset to understand this. Materials and Methods: Logistic regressions were performed to investigate the influence of diabetes on complication rates and procedure selection. Ethical approval was not required. Results: One thousand four hundred and seventy-five of these patients were suffering from T2D at the time of the surgery (416 diet-treated type 2 diabetes), 806 oral agent-treated type 2 diabetes, and 253 insulin-treated type 2 diabetes [ITD]). Six hundred and fifty (44.1%) of these patients underwent laparoscopic sleeve gastrectomy (LSG); 487 (33%) underwent Roux-en-Y gastric bypass; 230 (15.6%) underwent a one anastomosis gastric bypass (OAGB); and 108 (7.3%) underwent some other procedures. The 30-day mortality of BMS in those without T2D was 0.07% (4/5609) as compared to 0.4% (6/1475) and 0.8% (2/253) in those with T2D and ITD, respectively. 7.9% of those with T2D developed a 30-day complication compared to 6.5% without T2D (P = 0.0475). There was an increased risk of complications in patients with ITD on univariate and multivariate analysis. Patients with T2D were significantly less likely to undergo an LSG and significantly more likely to undergo an OAGB. Conclusions: ITD patients undergoing BMS experienced significantly higher 30-day morbidity and mortality. Although LSG was the most common procedure in patients with T2D, these patients were less likely to undergo LSG than patients without T2D.



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