{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:16:48Z","timestamp":1785824208342,"version":"3.56.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"None"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Concomitant liver biopsy during bariatric surgery has gained interest for diagnostic and research purposes, particularly in studying obesity-related liver disease. However, comprehensive data on safety remains limited using recent national databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of the MBSAQIP database from 2020 to 2022 was conducted. Patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy with or without concomitant liver biopsy were included. Primary outcomes were 30-day major complications (Clavien-Dindo grade III and IV) and mortality. Separate multivariable analyses were performed for bleeding-related complications including postoperative bleeding, transfusion requirements, and reoperation. Multivariable logistic regression analysis determined if concomitant liver biopsy independently predicted adverse outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 511,981 patients, 30,819 (6.02%) underwent concomitant liver biopsy. Biopsy patients had higher rates of diabetes (28.25% vs 22.65%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and hyperlipidemia (25.20% vs 22.14%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Mean operative time was longer in the biopsy group (96.10 vs 83.59 min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Unadjusted analysis showed higher rates of major complications (Clavien-Dindo grade III and IV) (3.15% vs 2.70%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 30-day readmission (3.32% vs 2.86%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in the biopsy group. However, on multivariable analysis, concomitant liver biopsy was not independently predictive of major complications (OR 0.91, 95%CI 0.79\u20131.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.164) or 30-day readmission (OR 1.06, 95%CI 0.94\u20131.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.344). Separate multivariable analyses for bleeding-related complications revealed that concomitant liver biopsy was independently associated with increased postoperative bleeding (OR 1.203, 95%CI 1.018\u20131.422,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030) and transfusion requirements (OR 1.171, 95%CI 1.028\u20131.334,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018), but not with reoperation (OR 1.016, 95%CI 0.908\u20131.138,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.783).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>After adjusting for patient factors, concomitant liver biopsy during bariatric surgery does not independently increase the risk of major complications (Clavien-Dindo grade III and IV), readmission, or mortality. However, it is associated with increased bleeding and transfusion complications. These findings support that liver biopsy can be performed during bariatric surgery, though clinicians should be prepared for increased bleeding-related risks and blood product utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11695-025-08267-9","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T15:39:19Z","timestamp":1758814759000},"page":"4752-4765","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Concomitant Liver Biopsy During Bariatric Surgery: No Increase in Major Complications or Readmissions but Associated with Higher Transfusion Requirements - An Analysis of the MBSAQIP Database"],"prefix":"10.1007","volume":"35","author":[{"given":"Juan S.","family":"Barajas-Gamboa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayanne","family":"Khoury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Mocanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lissa V.","family":"Wills","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Romero-Velez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Allemang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Strong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Navarrete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricard","family":"Corcelles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Daniel","family":"Guerron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Kroh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry T.","family":"Dang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"issue":"3","key":"8267_CR1","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1002\/oby.20174","volume":"21","author":"AX Holterman","year":"2013","unstructured":"Holterman AX, Guzman G, Fantuzzi G et al. Nonalcoholic fatty liver disease in severely obese adolescent and adult patients. Obesity (Silver Spring). 2013;21(3):591\u20137. https:\/\/doi.org\/10.1002\/oby.20174.","journal-title":"Obesity (Silver Spring)"},{"issue":"6","key":"8267_CR2","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1002\/hep.29068","volume":"65","author":"I Doycheva","year":"2017","unstructured":"Doycheva I, Watt KD, Alkhouri N. Nonalcoholic fatty liver disease in adolescents and young adults: the next frontier in the epidemic. Hepatology. 2017;65(6):2100\u20139. https:\/\/doi.org\/10.1002\/hep.29068.","journal-title":"Hepatology"},{"issue":"5","key":"8267_CR3","doi-asserted-by":"publisher","first-page":"e91","DOI":"10.1111\/j.2047-6310.2014.219.x","volume":"9","author":"KE Corey","year":"2014","unstructured":"Corey KE, Stanley TL, Misdraji J et al. Prevalence and outcome of non-alcoholic fatty liver disease in adolescents and young adults undergoing weight loss surgery. Pediatr Obes. 2014;9(5):e91\u20133. https:\/\/doi.org\/10.1111\/j.2047-6310.2014.219.x.","journal-title":"Pediatr Obes"},{"issue":"10","key":"8267_CR4","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.1016\/j.soard.2017.07.032","volume":"13","author":"S Barbois","year":"2017","unstructured":"Barbois S, Arvieux C, Leroy V et al. Benefit-risk of intraoperative liver biopsy during bariatric surgery: review and perspectives. Surg Obes Relat Dis. 2017;13(10):1780\u20136. https:\/\/doi.org\/10.1016\/j.soard.2017.07.032.","journal-title":"Surg Obes Relat Dis"},{"issue":"4","key":"8267_CR5","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1097\/HEP.0000000000000004","volume":"77","author":"ZM Younossi","year":"2023","unstructured":"Younossi ZM, Golabi P, Paik JM et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335\u201347. https:\/\/doi.org\/10.1097\/HEP.0000000000000004.","journal-title":"Hepatology"},{"issue":"1","key":"8267_CR6","doi-asserted-by":"publisher","first-page":"17","DOI":"10.7570\/jomes22021","volume":"31","author":"Y Huh","year":"2022","unstructured":"Huh Y, Cho YJ, Nam GE. Recent epidemiology and risk factors of nonalcoholic fatty liver disease. J Obes Metab Syndr. 2022;31(1):17\u201327. https:\/\/doi.org\/10.7570\/jomes22021.","journal-title":"J Obes Metab Syndr"},{"key":"8267_CR7","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-015-1224-7","volume":"8","author":"A Hillenbrand","year":"2015","unstructured":"Hillenbrand A, Kiebler B, Schwab C et al. Prevalence of non-alcoholic fatty liver disease in four different weight related patient groups: association with small bowel length and risk factors. BMC Res Notes. 2015;8: 290. https:\/\/doi.org\/10.1186\/s13104-015-1224-7.","journal-title":"BMC Res Notes"},{"issue":"5","key":"8267_CR8","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1007\/s10620-016-4095-4","volume":"61","author":"GB Goh","year":"2016","unstructured":"Goh GB, McCullough AJ. Natural history of nonalcoholic fatty liver disease. Dig Dis Sci. 2016;61(5):1226\u201333. https:\/\/doi.org\/10.1007\/s10620-016-4095-4.","journal-title":"Dig Dis Sci"},{"issue":"4","key":"8267_CR9","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1002\/hep.26031","volume":"56","author":"J Wattacheril","year":"2012","unstructured":"Wattacheril J, Chalasani N. Nonalcoholic fatty liver disease (NAFLD): is it really a serious condition? Hepatology. 2012;56(4):1580\u20134. https:\/\/doi.org\/10.1002\/hep.26031.","journal-title":"Hepatology"},{"issue":"4","key":"8267_CR10","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1097\/SLA.0b013e31826b4b7e","volume":"256","author":"VG Agopian","year":"2012","unstructured":"Agopian VG, Kaldas FM, Hong JC et al. Liver transplantation for nonalcoholic steatohepatitis: the new epidemic. Ann Surg. 2012;256(4):624\u201333. https:\/\/doi.org\/10.1097\/SLA.0b013e31826b4b7e.","journal-title":"Ann Surg"},{"issue":"3","key":"8267_CR11","doi-asserted-by":"publisher","first-page":"497","DOI":"10.14309\/ajg.0000000000002472","volume":"119","author":"F Kanwal","year":"2024","unstructured":"Kanwal F, Nelson R, Liu Y et al. Cost of care for patients with cirrhosis. Am J Gastroenterol. 2024;119(3):497\u2013504. https:\/\/doi.org\/10.14309\/ajg.0000000000002472.","journal-title":"Am J Gastroenterol"},{"key":"8267_CR12","doi-asserted-by":"publisher","unstructured":"De Luca M, Shikora S, Eisenberg D et al. Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO\/ASMBS). Obes Surg. 2024;34(11):3963\u20134096. https:\/\/doi.org\/10.1007\/s11695-024-07370-7.","DOI":"10.1007\/s11695-024-07370-7"},{"issue":"2","key":"8267_CR13","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1097\/MOT.0000000000000513","volume":"23","author":"K Bonner","year":"2018","unstructured":"Bonner K, Heimbach JK. Obesity management in the liver transplant recipient: the role of bariatric surgery. Curr Opin Organ Transplant. 2018;23(2):244\u20139. https:\/\/doi.org\/10.1097\/MOT.0000000000000513.","journal-title":"Curr Opin Organ Transplant"},{"issue":"2","key":"8267_CR14","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s11695-021-05797-w","volume":"32","author":"J Tseng","year":"2022","unstructured":"Tseng J, Korman J, Noureddin M et al. Routine versus selective liver biopsy during bariatric surgery: postoperative outcomes and preoperative predictors of NASH. Obes Surg. 2022;32(2):463\u201371. https:\/\/doi.org\/10.1007\/s11695-021-05797-w.","journal-title":"Obes Surg"},{"issue":"1 Suppl","key":"8267_CR15","doi-asserted-by":"publisher","first-page":"S65","DOI":"10.1016\/j.jhep.2015.02.041","volume":"62","author":"V Ratziu","year":"2015","unstructured":"Ratziu V, Goodman Z, Sanyal A. Current efforts and trends in the treatment of NASH. J Hepatol. 2015;62(1 Suppl):S65\u201375. https:\/\/doi.org\/10.1016\/j.jhep.2015.02.041.","journal-title":"J Hepatol"},{"issue":"1","key":"8267_CR16","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00464-021-08297-1","volume":"36","author":"B Clapp","year":"2022","unstructured":"Clapp B, Dodoo C, Kim J et al. Safety of liver biopsy at the time of bariatric surgery: an analysis of the MBSAQIP database. Surg Endosc. 2022;36(1):413\u201321. https:\/\/doi.org\/10.1007\/s00464-021-08297-1.","journal-title":"Surg Endosc"},{"issue":"8","key":"8267_CR17","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1136\/gutjnl-2020-321299","volume":"69","author":"J Neuberger","year":"2020","unstructured":"Neuberger J, Patel J, Caldwell H et al. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut. 2020;69(8):1382\u2013403. https:\/\/doi.org\/10.1136\/gutjnl-2020-321299.","journal-title":"Gut"},{"issue":"3","key":"8267_CR18","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.soard.2008.12.008","volume":"5","author":"CJ Dolce","year":"2009","unstructured":"Dolce CJ, Russo M, Keller JE et al. Does liver appearance predict histopathologic findings: prospective analysis of routine liver biopsies during bariatric surgery. Surg Obes Relat Dis. 2009;5(3):323\u20138. https:\/\/doi.org\/10.1016\/j.soard.2008.12.008.","journal-title":"Surg Obes Relat Dis"},{"key":"8267_CR19","doi-asserted-by":"publisher","unstructured":"Lee YH, Cho Y, Lee BW, Park CY, Lee DH, Cha BS, et al. Nonalcoholic fatty liver disease in diabetes. Part I: epidemiology and diagnosis. Diabetes Metab J. 2019;43(1):31\u201345. https:\/\/doi.org\/10.4093\/dmj.2019.0011. Erratum in: Diabetes Metab J. 2019;43(5):731. https:\/\/doi.org\/10.4093\/dmj.2019.0188.","DOI":"10.4093\/dmj.2019.0011"},{"issue":"1","key":"8267_CR20","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s11695-019-04136-4","volume":"30","author":"RE Jones","year":"2020","unstructured":"Jones RE, Yeh AM, Kambham N et al. Intraoperative liver biopsy during adolescent bariatric surgery: is it really necessary? Obes Surg. 2020;30(1):69\u201376. https:\/\/doi.org\/10.1007\/s11695-019-04136-4.","journal-title":"Obes Surg"},{"issue":"1","key":"8267_CR21","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s11695-015-1916-z","volume":"26","author":"KK Mahawar","year":"2016","unstructured":"Mahawar KK, Parmar C, Graham Y et al. Routine liver biopsy during bariatric surgery: an analysis of evidence base. Obes Surg. 2016;26(1):177\u201381. https:\/\/doi.org\/10.1007\/s11695-015-1916-z.","journal-title":"Obes Surg"},{"issue":"9","key":"8267_CR22","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1016\/j.mayocp.2015.06.013","volume":"90","author":"EK Spengler","year":"2015","unstructured":"Spengler EK, Loomba R. Recommendations for diagnosis, referral for liver biopsy, and treatment of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Mayo Clin Proc. 2015;90(9):1233\u201346. https:\/\/doi.org\/10.1016\/j.mayocp.2015.06.013.","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"8267_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1055\/s-0034-1371549","volume":"34","author":"EC Verna","year":"2014","unstructured":"Verna EC. Liver biopsy at the time of bariatric surgery: a benefit for patients and the medical community. Semin Liver Dis. 2014;34(1):1\u20136. https:\/\/doi.org\/10.1055\/s-0034-1371549.","journal-title":"Semin Liver Dis"},{"issue":"12","key":"8267_CR24","doi-asserted-by":"publisher","first-page":"2280","DOI":"10.1007\/s11695-015-1691-x","volume":"25","author":"G Bower","year":"2015","unstructured":"Bower G, Toma T, Harling L, et al. Bariatric surgery and non-alcoholic fatty liver disease: a systematic review of liver biochemistry and histology. Obes Surg. 2015;25(12):2280\u20139. https:\/\/doi.org\/10.1007\/s11695-015-1691-x.","journal-title":"Obes Surg"},{"issue":"1","key":"8267_CR25","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12893-021-01296-y","volume":"21","author":"L Wei","year":"2021","unstructured":"Wei L, Li M, Zeng N, et al. Bariatric surgery for non-alcoholic fatty liver disease in individuals with obesity (Base-NAFLD): protocol of a prospective multicenter observational follow-up study. BMC Surg. 2021;21(1):298. https:\/\/doi.org\/10.1186\/s12893-021-01296-y.","journal-title":"BMC Surg"},{"issue":"1","key":"8267_CR26","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","volume":"64","author":"ZM Younossi","year":"2016","unstructured":"Younossi ZM, Koenig AB, Abdelatif D et al. Global epidemiology of nonalcoholic fatty liver disease\u2014meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73\u201384. https:\/\/doi.org\/10.1002\/hep.28431.","journal-title":"Hepatology"},{"issue":"2","key":"8267_CR27","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1002\/hep.27173","volume":"60","author":"P Bedossa","year":"2014","unstructured":"Bedossa P, FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology. 2014;60(2):565\u201375. https:\/\/doi.org\/10.1002\/hep.27173.","journal-title":"Hepatology"},{"issue":"12","key":"8267_CR28","doi-asserted-by":"publisher","first-page":"2368","DOI":"10.1007\/s11695-015-1707-6","volume":"25","author":"A Petrick","year":"2015","unstructured":"Petrick A, Benotti P, Wood GC et al. Utility of ultrasound, transaminases, and visual inspection to assess nonalcoholic fatty liver disease in bariatric surgery patients. Obes Surg. 2015;25(12):2368\u201375. https:\/\/doi.org\/10.1007\/s11695-015-1707-6.","journal-title":"Obes Surg"},{"issue":"1","key":"8267_CR29","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s11695-019-04161-3","volume":"30","author":"H Collins","year":"2020","unstructured":"Collins H, Beban G, Windsor J et al. Safety and utility of liver biopsy during bariatric surgery in the New Zealand setting. Obes Surg. 2020;30(1):313\u20138. https:\/\/doi.org\/10.1007\/s11695-019-04161-3.","journal-title":"Obes Surg"},{"issue":"11","key":"8267_CR30","doi-asserted-by":"publisher","first-page":"2078","DOI":"10.1007\/s11695-015-1655-1","volume":"25","author":"P Praveenraj","year":"2015","unstructured":"Praveenraj P, Gomes RM, Kumar S et al. Prevalence and predictors of non-alcoholic fatty liver disease in morbidly obese South Indian patients undergoing bariatric surgery. Obes Surg. 2015;25(11):2078\u201387. https:\/\/doi.org\/10.1007\/s11695-015-1655-1.","journal-title":"Obes Surg"},{"issue":"14","key":"8267_CR31","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1001\/jama.292.14.1724","volume":"292","author":"H Buchwald","year":"2004","unstructured":"Buchwald H, Avidor Y, Braunwald E et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724\u201337. https:\/\/doi.org\/10.1001\/jama.292.14.1724.","journal-title":"JAMA"},{"issue":"11","key":"8267_CR32","doi-asserted-by":"publisher","first-page":"8682","DOI":"10.1007\/s00464-023-10305-5","volume":"37","author":"JS Barajas-Gamboa","year":"2023","unstructured":"Barajas-Gamboa JS, Moon S, Romero-Velez G et al. Primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy to SADI conversions: a comparison study of prevalence and safety. Surg Endosc. 2023;37(11):8682\u20139. https:\/\/doi.org\/10.1007\/s00464-023-10305-5.","journal-title":"Surg Endosc"},{"issue":"3","key":"8267_CR33","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s11695-020-04395-6","volume":"30","author":"V Mocanu","year":"2020","unstructured":"Mocanu V, Dang JT, Switzer N et al. Sex and race predict adverse outcomes following bariatric surgery: an MBSAQIP analysis. Obes Surg. 2020;30(3):1093\u2013101. https:\/\/doi.org\/10.1007\/s11695-020-04395-6.","journal-title":"Obes Surg"}],"container-title":["Obesity Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-025-08267-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11695-025-08267-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-025-08267-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T14:20:44Z","timestamp":1762525244000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11695-025-08267-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":33,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["8267"],"URL":"https:\/\/doi.org\/10.1007\/s11695-025-08267-9","relation":{},"ISSN":["0960-8923","1708-0428"],"issn-type":[{"value":"0960-8923","type":"print"},{"value":"1708-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]},"assertion":[{"value":"29 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was exempt from institutional review board approval as it utilized de-identified data from the MBSAQIP database. The MBSAQIP is a national quality improvement registry that is open to participating institutions, and the use of its de-identified data for research purposes does not require individual patient consent. As such, the need for specific ethical approval was waived for this retrospective analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and Animal Rights\/Ethical Approval"}},{"value":"Due to the retrospective nature of this study, the need for informed consent was waived by the research ethical committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}