Predictors of Postoperative Complications in Metabolic and Bariatric Surgery: A Retrospective Analysis Using Multivariable Logistic Regression

Background and Objectives: Metabolic and bariatric surgery is the most effective long-term intervention for severe obesity, associated with significant reductions in weight, associated medical problems, and cancer risk. While the overall safety profile of metabolic and bariatric surgery has improved, early postoperative complications still occur and may lead to prolonged hospitalization, reintervention, or increased morbidity. This study aimed to identify independent preoperative and perioperative predictors of early postoperative complications following metabolic and bariatric surgery. Materials and Methods: We conducted a retrospective cohort study of 927 patients who underwent metabolic and bariatric surgery at a single tertiary medical center between December 2017 and March 2022. Early postoperative complications, defined as those occurring during the index hospitalization or within 90 days, were recorded and graded using the Clavien-Dindo classification. Univariate analyses were performed to identify candidate predictors, followed by multivariable logistic regression using an unpenalized model. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using maximum likelihood methods with Wald-based intervals. Results: Eighty-four patients (9.1%) experienced postoperative complications, with 38% requiring invasive intervention. Bleeding was the most common complication (46%), followed by leak/intra-abdominal abscess (24%) and cardiorespiratory events (18%). Independent predictors of complications included obstructive sleep apnea (OR: 1.93), bariatric surgery within the past 5 years (OR: 2.39). Conclusions: OSA and recent previous surgery increase the risk of early complications after metabolic and bariatric surgery. These findings support integrating specific risk factors into preoperative planning to improve surgical outcomes.