Outcomes from Reoperative Bariatric Surgery: A Needs Assessment

Background: Bariatric surgery is the gold standard treatment for severe obesity. When weight regain, insufficient weight loss, or complications occur after bariatric surgery, a second surgery may be required. Reoperative bariatric surgery is a newer and more complex procedure with limited studies or guidelines in the literature. The purpose of this needs assessment was to perform a detailed chart review to assess the outcomes from reoperative bariatric surgery at one weight treatment center in Millcreek, Utah, and to provide stakeholders with recommendations from the literature to improve outcomes. Methods: This project assessed outcomes from reoperative bariatric surgery in all 120 patients who underwent reoperation at St. Mark's Hospital between 2017 and 2020. This consisted of a detailed chart review of each patient in both the clinic and hospital electronic health records using a checklist derived from multiple studies in the literature. The rate of complications, improvement of comorbidities, and change in body mass index were then determined, and the data was organized into tables to demonstrate the findings. Recommendations were developed to improve outcomes. The findings and recommendations were then presented to the stakeholders in an executive report. Feedback was obtained from the stakeholders about feasibility, usability, and satisfaction with the project and recommendations. Results: The chart review revealed a total complication rate of 58%. Eighteen percent of cases were associated with minor complications only, and 39% were associated with at least one major complication. The mortality rate was 2.5%. Median decrease in body mass index after one year was 13.53 kg/𝑚ଶ, and the rate of comorbidity improvement was 19%. The median duration of follow-up was eight months, with 60% of patients lost to follow-up before one year. Stakeholder satisfaction with the project and intent to utilize the findings in their practice was 100%. Conclusions: Fifty-eight percent of cases were associated with at least one complication, while comorbidity improvement was reported in 19% of patient records. Gaps were identified in attendance of follow-up visits after surgery and in addressing comorbidity improvement at follow-up visits. Recommendations from the literature to increase the rate of follow-up attendance were provided to the stakeholders, and 100% of them reported intention to implement the recommendations into their practice.