Abstract
There are few nationwide studies comparing the risk of reintervention after contemporary bariatric procedures. To compare the risk of intervention after Roux-en-Y gastric bypass (RYGB) vs vertical sleeve gastrectomy (VSG). This cohort study used a nationwide US commercial insurance claims database. Adults aged 18 to 64 years who underwent a first RYGB or VSG procedure between January 1, 2010, and June 30, 2017, were matched on US region, year of surgery, most recent presurgery body mass index (BMI) category (based on diagnosis codes), and baseline type 2 diabetes. The prematch pool included 4496 patients undergoing RYGB and 8627 patients undergoing VSG, and the final weighted matched sample included 4476 patients undergoing RYGB and 8551 patients undergoing VSG. Bariatric surgery procedure type (RYGB vs VSG). The primary outcome was any abdominal operative intervention after the index procedure. Secondary outcomes included the following subtypes of operative intervention: biliary procedures, abdominal wall hernia repair, bariatric conversion or revision, and other abdominal operations. Nonoperative outcomes included endoscopy and enteral access. Time to first event was compared using multivariable Cox proportional hazards regression modeling. Among 13 027 patients, the mean (SD) age was 44.4 (10.3) years, and 74.1% were female; 13.7% had a preoperative BMI between 30 and 39.9, 45.8% had a preoperative BMI between 40 and 49.9, and 24.2% had a preoperative BMI of at least 50. Patients were followed up for up to 4 years after surgery (median, 1.6 years; interquartile range, 0.7-3.2 years), with 41.9% having at least 2 years of follow-up and 16.3% having at least 4 years of follow-up. Patients undergoing VSG were less likely to have any subsequent operative intervention than matched patients undergoing RYGB (adjusted hazard ratio [aHR], 0.80; 95% CI, 0.72-0.89) and similarly were less likely to undergo biliary procedures (aHR, 0.77; 95% CI, 0.67-0.90), abdominal wall hernia repair (aHR, 0.60; 95% CI, 0.47-0.75), other abdominal operations (aHR, 0.71; 95% CI, 0.61-0.82), and endoscopy (aHR, 0.54; 95% CI, 0.49-0.59) or have enteral access placed (aHR, 0.58; 95% CI, 0.39-0.86). Patients undergoing VSG were more likely to undergo bariatric conversion or revision (aHR, 1.83; 95% CI, 1.19-2.80). In this nationwide study, patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures. Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB vs VSG as part of shared decision-making around procedure choice.
Highlights
Operative reintervention is among the most concerning sequelae of bariatric surgery
Patients undergoing vertical sleeve gastrectomy (VSG) were less likely to have any subsequent operative intervention than matched patients undergoing Roux-en-Y gastric bypass (RYGB) and were less likely to undergo biliary procedures, abdominal wall hernia repair, other abdominal operations, and endoscopy or have enteral access placed
Risk of Interventions After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy. In this nationwide study, patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures
Summary
Operative reintervention is among the most concerning sequelae of bariatric surgery. It can occur within days or weeks because of problems like anastomotic leak, infection, or hemorrhage[1,2] or years later, with revisional procedures performed to enhance weight loss or address chronic complications.[3]. Differences in reintervention rates between Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG), the most common contemporary bariatric procedures, have been understudied.[1,7,8,9] Most relevant prior comparative studies have examined reoperation rates by 30 days[10,11,12] or 1 to 2 years after an index procedure.[13,14,15] Analyses with longer follow-up time have been characterized by small sample sizes that limit assessment of operation subtypes[16,17] or were singlecenter studies,[18,19] limiting generalizability Another potential limitation of prior observational studies of reoperation is reliance on clinical registry or electronic health record data,[14,18,20,21] leading to incomplete capture of subsequent surgical procedures performed outside of the health system under study. The present analysis uses a nationwide US commercial insurance claims database to compare matched cohorts of patients undergoing RYGB vs patients undergoing VSG with respect to subsequent abdominal operative interventions (AOIs), as well as subcategories of operations and invasive but nonoperative interventions, up to 4 years after an index procedure
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