Sa1957 ENDOSCOPIC BARIATRIC THERAPIES ASSOCIATED WITH LOWER RATE OF ADVERSE EVENTS AND LENGTH OF STAY THAN LAPAROSCOPIC BARIATRIC THERAPIES

Abstract

Endoscopic bariatric therapies (EBTs) have become increasingly popular as a minimally invasive alternative to surgical bariatric procedures. The safety and efficacy of EBTs has been explored in multiple retrospective studies and landmark clinical trials. However, there is minimal research on real-world, large-volume data comparing EBTs to laparoscopic bariatric therapies (LBTs). This study aimed to compare 30-day post-operative morbidity and mortality outcomes of primary EBTs vs LBTs using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), the largest available database containing 204,837 cases from 854 centers in 2018. Adult patients were included with BMI ranging betwee 35-40 kg/m2, since that is the range of overlap of endoscopic and surgical procedures. Only laparoscopic surgical procedures were included. Revision or conversion surgeries were excluded. Of the EBTs, the intragastric balloon (IGB) was excluded from this study because it has been previously extensively studied in the literature and has also been studied from this database. Propensity score matching 1:50 was performed for EBTs versus LBTs based on age, sex, and BMI. Primary outcome was adverse events (AE), which was defined by the occurrence of any one of the 24 recorded adverse events in the database. Secondary outcomes included readmission, reoperation, reintervention, length of stay, and death. Multivariable logistic regression controlling for baseline comorbidities was used to compare the two groups with respect to the occurrence of an AE. A p-value of < 0.05 was considered significant. 252 EBTs were matched with 10,925 LBTs. Table 1 shows the demographic characteristics and comorbidities of the groups after matching. Operative length was significantly lower in the EBT group than the LBT group (64.3 ± 37.7 versus 80.6 ± 45.9, p < 0.001). Length of stay post-procedure was also significantly lower in the EBT group than the LBT group (incidence risk ratio=0.59, 95% CI:0.52, 0.67, p<0.001). Rate of readmission (3.36% in LBTs vs 3.57% in EBTs, p=0.85), reoperation (1.25% in LBTs vs 0.29% in EBTs, p=0.51), reintervention (1.03% in LBTs vs 1.98% in EBTs, p=0.14), and death (0.05% in LBTs vs 0% in EBTs, p=0.73) were not significantly different between the two groups. The overall rate of AEs was lower in the EBT group (5.56%) than the LBT group (10.72%, p<0.01). After controlling for the following comorbidities: COPD, sleep apnea, history of myocardial infarction, hypertension requiring medications, and diabetes, EBTs continued to be associated with a lower AE risk than LBTs, with an odds ratio of 0.48 (95% CI: 0.28, 0.83, p<0.01). EBTs are associated with a lower 30-day AE rate and shorter length of stay than LBTs, with a similar readmission, reintervention, and reoperation rate.