ArticleObesity surgery2025
Conversion To Open Approach in Primary Bariatric Surgery: A MBSAQIP Cohort Analysis of 524 224 Patients Evaluating Complications of and Risk Factors for Conversion.
Article in Obesity surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionBariatric surgery is primarily performed using minimally invasive techniques. Intraoperative conversion to open is associated with increased complications. This study aimed to provide a contemporary overview of frequency of conversion to open, compare complication rates and determine factors associated with conversion.
methodsThe MBSAQIP database from 2020 to 2022 was analyzed to identify two cohorts; those who underwent a minimally invasive approach and those who required conversion to open. Patients undergoing primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodenal-ileal bypass (SADI) were included. Univariate analysis was performed to characterize differences and assess for rate of complications between cohorts. Multivariate logistic regression was performed to determine factors associated with conversion and 30-day serious complications.
resultsA total of 524 224 patients were identified of which 181 (0.03%) required conversion to open. Factors associated with increased risk of conversion to open included age, BMI, lower albumin, sleep apnea, undergoing RYBG or BPD-DS (vs. SG) and previous foregut surgery. Patients converted were more likely to have 30-day reoperation, reintervention, or readmission on bivariate analysis. Conversion to open was also an independent predictor of serious complications on multivariate analysis.
conclusionConversion to open in bariatric surgery is rare but associated with significant increased risk of postoperative complications. Patients at increased risk may benefit from preoperative risk mitigation, such as those undergoing BPD-DS or RYGB, with sleep apnea, or with a history of previous foregut surgery.
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