An Expanded Examination of Outcomes from Revisional Bariatric Surgery: A Needs Assessment

Background: Bariatric surgery has been established as the first-line treatment for morbid obesity. Revisional bariatric surgery follows a failed or complicated primary bariatric procedure; however, the outcomes of revisional bariatric surgery remain controversial. The current recommendation for revisional surgery is to follow guidelines for primary surgery despite the significant differences. There is also a lack of evidence demonstrating the benefit of revisions, such as weight loss achievement and comorbidity improvement. This gap makes it difficult to assess the risk versus benefits of revisional bariatric surgery. Local Problem: As obesity rates increase exponentially, bariatric surgery is becoming more common, the cohort of patients is younger, and the need for revisional surgery is rising. A previous analysis was done, at St. Mark's Weight Treatment Center (SMWTC), to assess the benefits and complications of revisional surgery in their practice. Further analysis is required to understand whether these results are clinically significant and comparable to nationwide outcomes. Methods: This quality improvement project assessed outcomes from revisional bariatric surgery in 160 patients who had a revision done at St. Mark's Hospital between 2017 and 2021. A retrospective chart review was conducted using a checklist derived from the literature and was edited based on recommendations from the previous analysis. Data were extracted regarding complications, the timing of complications, and benefits from revisional surgery. The results were analyzed, and recommendations were developed from the literature with strategies to improve future surgery outcomes. Interventions: Data extraction began with the patient's preoperative visit and continued until their follow-up one year after surgery. Supplemental data were gathered by an employee who conducted follow-up phone calls to patients who are now two to five years post-revision to assess current BMI and comorbidity improvement. The data were organized into tables and figures to demonstrate the findings. An executive report, including recommendations, was presented to the team at SMWTC, and feedback was obtained about usability and satisfaction with the results. Results: The chart review revealed a total complication rate of 54%, with 20% of patients experiencing a minor complication only and 34% experiencing at least one major complication. The median decrease in BMI was 13.14 kg/m², and 21% of patients had documented comorbidity improvement. Two to five years post revision, 50% of comorbidities were described as much better or somewhat better by patients. One hundred percent of the team at SMWTC reported being very likely to implement recommendations into practice and being very satisfied with the findings and report. Conclusion: The findings from this study revealed a moderate complication rate, a mortality rate comparable to the literature, and a clinically significant decrease in BMI and rate of comorbidity improvement at one year of follow-up as well as two to five years post revisional surgery. The surgical team reported that this project was worthwhile, sustainable, and impactful in their practice. This information can help inform surgical decision-making, and the results of this study can guide patient counseling for those pursuing revisional bariatric surgery.