Interventions and Operations after Bariatric Surgery in a Health Plan Research Network Cohort from the PCORnet, the National Patient-Centered Clinical Research Network

Abstract

Purpose Obesity is a highly prevalent condition with severe clinical burden. Bariatric procedures are an important and expanding treatment option. This study compared short-(30-day composite adverse events) and long-term (intervention/operation, endoscopy, hospitalization, and mortality up to 5 years) safety outcomes associated with three bariatric surgical procedures. Materials and Methods This observational cohort study replicated an electronic health record study comparing short- and long-term problems associated with three bariatric surgical procedures between January 1, 2006, and September 30, 2015, within a Health Plan Research Network. Results Of 95,251 adults, 34,240 (36%) underwent adjustable gastric banding (AGB), 36,206 (38%) Roux-en-Y gastric bypass (RYGB), and 24,805 (26%) sleeve gastrectomy (SG). Median (interquartile range) years of follow-up was 3.3 (1.4–5.0) (AGB), 2.5 (1.0–4.6) (RYGB), and 1.1 (0.5–2.1) (SG). Overall mean (SD) age was 44.2 (11.4) years. The cohort was predominantly female (76%). Thirty-day composite adverse events occurred more frequently following RYGB (3.8%) than AGB (3.1%) and SG (2.8%). Operation/intervention was less likely in SG than in RYGB (adjusted hazard ratio (AHR), 0.87; 95%CI, 0.80–0.96; P=0.003), and more likely in AGB than in RYGB (AHR, 2.10; 95%CI, 2.00–2.21; P<0.001). Hospitalization was less likely after ABG and SG than after RYGB: AGB vs. RYGB, AHR=0.73; 95%CI, 0.71–0.76; P<0.001; SG vs. RYGB, AHR=0.79; 95%CI, 0.76–0.83; P<0.001. Mortality was most likely for RYGB (SG vs. RYGB: AHR, 0.76; 95%CI, 0.64–0.92; P=0.004; AGB vs. RYGB: AHR, 0.49; 95%CI, 0.43–0.56; P=0.001). Conclusions Interventions, operations, and hospitalizations were more often associated with AGB and RYGB than SG while RYGB had the lowest risk for revision. Graphical abstract

Long term cost outcomes among commercially insured patients undergoing bariatric surgical procedures

“…Weiner's study consisted of patients who underwent BS from 2002 to 2008, in which 12.3% of study participants AGB, 38.3% had laparoscopic gastric bypass, and 35.4% had open gastric bypass. However, 46.8% of patients in the current study underwent the SG procedure, which has shown to be safer with less risk of hospitalization in both the short‐ and long‐term than AGB and bypass 11,13 …”

“…which has shown to be safer with less risk of hospitalization in both the short-and long-term than AGB and bypass. 11,13 A study by Smith et al, that looked at bariatric surgeries between 2000 and 2011 using Veterans' Affairs (VA) health care system data to study 10-year downstream healthcare cost, saw increases in total health care expenditures in the first 2 years after BS and then observed similar costs to the non-surgery group in the next 8 years. 18 In contrast, this study saw increased Year 1 cost followed by decreased Year 2 to Year 10 cost in the surgery group.…”

“…Existing research has demonstrated superior effects of BS on weight loss and glycemic control compared to traditional medical approaches for treating obesity. 6 , 7 , 8 , 9 In addition, laparoscopic approaches have made BS safer and less invasive in the past decade 10 , 11 and common bariatric procedures have also changed over time, with the Sleeve Gastrectomy (SG) gaining popularity in recent years. 11 , 12 , 13 Studies show that the SG is comparably more effective than Adjustable Gastric Band (AGB) and Roux‐en‐Y Gastric Bypass (RYGB) (five‐year mean total weight loss of 25.5% for RYGB, 18.8% for SG, and 11.7% for AGB) 12 and 30‐day composite adverse events were less common following SG (2.8%) than other bariatric surgeries (RYGB [3.8%] and AGB [3.1%]).…”

“… 11 , 12 , 13 Studies show that the SG is comparably more effective than Adjustable Gastric Band (AGB) and Roux‐en‐Y Gastric Bypass (RYGB) (five‐year mean total weight loss of 25.5% for RYGB, 18.8% for SG, and 11.7% for AGB) 12 and 30‐day composite adverse events were less common following SG (2.8%) than other bariatric surgeries (RYGB [3.8%] and AGB [3.1%]). 11 …”

“…[6][7][8][9] In addition, laparoscopic approaches have made BS safer and less invasive in the past decade 10,11 and common bariatric procedures have also changed over time, with the Sleeve Gastrectomy (SG) gaining popularity in recent years. [11][12][13] Studies show that the SG is comparably more effective than Adjustable Gastric Band (AGB) and Roux-en-Y Gastric Bypass (RYGB) (five-year mean total weight loss of 25.5% for RYGB, 18.8% for SG, and 11.7% for AGB) 12 and 30-day composite adverse events were less common following SG (2.8%) than other bariatric surgeries (RYGB [3.8%] and AGB [3.1%]). 11 Even though bariatric surgeries have evolved and are becoming increasingly common, there are racial and socioeconomic status disparities in the use of BS.…”