Abstract
PurposeObesity 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 MethodsThis 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.ResultsOf 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).ConclusionsInterventions, operations, and hospitalizations were more often associated with AGB and RYGB than SG while RYGB had the lowest risk for revision.Graphical abstract
Highlights
An estimated 93.3 million American adults were affected by obesity in 2015–2016; the estimated prevalence rate in adults was 39.8%, and 18.5% in youths, with a substantial portion severe enough to merit consideration of bariatric surgery [1]
Roux-en-Y gastric bypass (RYGB) was predominant in the early 2000s; by the late 2000s, adjustable gastric banding (AGB) procedure had become more widely used. Both RYGB and AGB appear to have waned in popularity following the emergence of sleeve gastrectomy (SG), which is the most commonly used bariatric procedure currently[13, 14]
Regarding the risk of revisional procedures, we found AGB patients had higher risk than RYGB and SG patients, consistent with the fact that ABG has been largely abandoned as a bariatric procedure owing to concerns about insufficient weight loss and the need for reoperation due to band failures and slippage
Summary
An estimated 93.3 million American adults were affected by obesity in 2015–2016; the estimated prevalence rate in adults was 39.8%, and 18.5% in youths, with a substantial portion severe enough (body mass index > 35 kg/m2 ) to merit consideration of bariatric surgery [1]. Because of its already high and increasing prevalence rate, obesity is deemed an epidemic by the Centers of Disease Control and Prevention [2]. Obesity is linked to several leading causes of preventable death including cardiovascular disease, type 2 diabetes, and some cancers, exacting a severe clinical burden [3]. Roux-en-Y gastric bypass (RYGB) was predominant in the early 2000s; by the late 2000s, adjustable gastric banding (AGB) procedure had become more widely used. Both RYGB and AGB appear to have waned in popularity following the emergence of sleeve gastrectomy (SG), which is the most commonly used bariatric procedure currently[13, 14]
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