The incidence and determinants of bariatric reoperations: a population-based cohort study

Background: Bariatric surgery is the strongest evidence-based treatment available for obesity, but the long-term morbidity and durability of these procedures is being increasingly scrutinized. Objective: To report the incidence, timing, indications, and risk factors for bariatric reoperations. Setting: A state-wide, multicenter, retrospective study. Methods: Using the Western Australian Department of Health Data Linkage Unit, all patients undergoing an index bariatric procedure where identified across a 10-year period (2007–2016). Results: Of 24,766 patients who underwent bariatric surgery, 5001 patients (20.2%) required at least 1 bariatric reoperation. The 5-yearly rates were 19.6% (95% confidence interval [CI], 19.0%–20.2%) for a first revision, 58.2% (95%CI, 56.6%–59.8%) for a subsequent second revision, 38.3% (95%CI, 35.4%–41.2%) for a subsequent third revision, and 45.2% (95%CI, 39.9%–50.5%) for a subsequent fourth revision. Surgical complications (67.4%) were the main indication for any bariatric reoperation ahead of weight-related causes (32.6%). In a Cox regression analysis, being younger, female, without private health insurance, and having a gastric band as the initial bariatric procedure were all significant risk factors for bariatric reoperations. Compared with bariatric patients needing only an index procedure, patients requiring bariatric reoperations also had higher postoperative incidence rate ratios of endoscopic (incidence rate ratio 2.4; 95%CI, 2.3–2.5) and body contouring (incidence rate ratio 3.8; 95%CI, 3.5–4.1) procedures. Conclusions: Patients undergoing bariatric surgery had a high incidence of bariatric reoperations, predominantly for surgical complications. Of those patients who required bariatric reoperations, there were additional high rates of recurrent bariatric surgery, postoperative endoscopy, and body contouring procedures.