Gastroesophageal reflux disease as a risk factor for postoperative complications in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program registry (2015-2022): implications for preoperative evaluation.

Background: Gastroesophageal reflux disease (GERD) is frequently reported in metabolic surgery patients and has been associated with increased postoperative complications. However, variability in GERD diagnosis, reliance on self-reported symptoms, and medication use may be confounding factors.

Objectives: Evaluate GERD as an independent risk factor for postoperative outcomes.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), 2015-2022.

Methods: A total of 1,577,175 cases (sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB], or biliopancreatic diversion/duodenal switch) were available for inclusion. Exclusions included age <18, body mass index <30, missing sex or operative length, and revisions/conversions. Adjusted logistic regression models evaluated GERD as a predictor of 30-day and procedure-specific outcomes (SG, RYGB). All statistical analyses were performed using R, version 4.4.1.

Results: Overall, a total of 1,282,883 patients met inclusion criteria, and patients were more likely to undergo SG than RYGB regardless of the GERD status. GERD diagnosis was present in 30.5% of patients. Preoperatively, GERD was associated with clinically relevant differences in cardiac history and was also associated with increased odds of postoperative complications, including infections (odds ratio [OR], 1.27), serious complications (OR, 1.20), and 30-day readmission (OR, 1.26).

Conclusion: After adjustment for co-morbidities, GERD was associated with modestly increased odds of adverse events after metabolic and bariatric surgery. In addition, SG was the most performed procedure among patients with GERD despite clinical recommendations favoring RYGB. Surgeons should consider a preoperative GERD diagnosis-as defined in the MBSAQIP-as a potential marker for identifying patients who may warrant enhanced perioperative risk assessment and optimization of coexisting co-morbidities.