Impact of obstructive sleep apnea on postoperative outcomes after SADI-S: a retrospective MBSAQIP database analysis with literature review on behalf of TROGSS - The Robotic Global Surgical Society

Aim: Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a hypo-absorptive bariatric procedure with promising weight-loss and metabolic outcomes. The impact of obstructive sleep apnea (OSA), a common obesity-related comorbidity, on surgical outcomes following SADI-S remains underexplored. This study assesses 30-day postoperative outcomes in patients with OSA who underwent SADI-S, utilizing data from the MBSAQIP database (2020-2022). Methods: Patients undergoing primary SADI-S between January 1, 2020, and December 31, 2022, were identified from the MBSAQIP database. Comparative analyses between patients with and without OSA were conducted using 19 preoperative variables and 17 postoperative outcomes. Continuous variables were analyzed with the Student’s t -test, and categorical variables using the chi-square test. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and multivariate logistic regression models identified independent predictors of OSA. Statistical significance was set at P < 0.05. Results: A total of 1,301 patients were analyzed, with 596 (45.8%) having OSA. OSA patients were older (45.84 ± 10.14 years vs . 40.67 ± 10.55 years, P < 0.001), had higher body mass index (BMI) (50.57 ± 9.91 kg/m2 vs . 49.05 ± 8.50 kg/m2, P = 0.003), and more comorbidities such as diabetes, hypertension, and hyperlipidemia. OSA was associated with longer operative times (144.30 ± 58.92 min vs . 127.41 ± 54.59 min, P < 0.001) and increased blood transfusions (1.7% vs . 0.3%, P = 0.009), but no significant differences in mortality, pulmonary embolism, or readmission rates. Multivariate analysis identified male sex (OR: 3.306, P < 0.001), age (OR: 2.077, P < 0.001), and higher American Society of Anesthesiologists (ASA) classification (OR: 2.133, P < 0.001) as independent predictors of OSA. Conclusion: Patients with OSA undergoing SADI-S experience longer operative times and an increased risk of blood transfusions, which is primarily an intraoperative or early postoperative event. However, OSA does not significantly impact key short-term postoperative outcomes, such as mortality, pulmonary embolism, or readmission rates. These findings support the safety and efficacy of SADI-S in OSA patients, emphasizing the need for careful intraoperative management while maintaining favorable postoperative outcomes.