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Surg Obes Relat Dis. 2017 May;13(5):826-834. doi: 10.1016/j.soard.2017.01.021. Epub 2017 Jan 19.

Comparative effectiveness of primary bariatric operations in the United States.

Author information

1
School of Medicine, Department of Surgery, Duke University, Durham, North Carolina. Electronic address: Ranjan.sudan@duke.edu.
2
School of Medicine, Department of Surgery, Duke University, Durham, North Carolina; Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina.
3
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
4
Irvine School of Medicine, University of California, Irvine, Department of Surgery, California.
5
CHI Memorial Hospital, Chattanooga, Tennessee.
6
Department of Surgery, Stanford University, Palo Alto, California.

Abstract

BACKGROUND:

Four current bariatric operations were compared after matching patients for differences at baseline. Operations with greater weight loss and resolution of co-morbidities also incurred more adverse events. Reflux was best treated by gastric bypass and type 2 diabetes with duodenal switch. These results can guide decision making regarding choice of bariatric operation. Relative outcomes of common primary bariatric operations have not been compared previously in a large multisite cohort from surgeons in multiple surgical centers.

OBJECTIVE:

Compare outcomes of primary bariatric operations in a matched national sample.

SETTING:

Bariatric Surgery Centers of Excellence in the United States of America METHODS: Data from Bariatric Surgery Center of Excellence Data File was queried from June 2007 to September 2011 for 30-day and 1-year adverse events, 1-year weight loss and comorbidity resolution. Inverse probability weighting accounted for covariate imbalances in multivariable linear/logistic regressions estimates of differences/odds ratios for each pairwise surgical procedure comparison. A Bonferroni correction was applied to account for multiple pairwise comparisons.

RESULTS:

Among 130,796 patients, 57,094 patients underwent AGB, 5942 patients underwent SG, 66,324 patients underwent RYGB and 1436 patients underwent BPD/DS. Compared with AGB, change in body mass index units at 1 year for BPD/DS was 10.6 (standard error [SE]: .15), RYGB 9.3 (SE: .03), and SG 5.7 (SE: .06). Resolution of GERD was best for RYGB (odds ratio [OD] = 1.5, 95% confidence interval [CI]: 1.48-1.58) and lowest for SG (OR = 0.87, 95% CI: .79-.95). Hypertension and T2D resolution were better after the BPD/DS (OR = 3.82, 95% CI: 3.21-4.55, and OR = 5.62, 95% CI: 4.60-6.88, respectively) or after RYGB (OR = 3.08, 95% CI: 2.98-3.18 and OR = 3.5, 95% CI: 3.39-3.64, respectively). Odds of serious adverse events at 1 year were: SG, OR = 3.22, 95% CI: 2.64-3.92; RYGB, OR = 4.92, 95% CI: 4.38-5.54; BPD/DS, OR = 17.47, 95% CI: 14.19-21.52.

CONCLUSION:

Odds of adverse events and co-morbidity resolution were determined after matching for baseline characteristics. RYGB was associated with highest resolution of GERD, whereas BPD/DS was associated with highest resolution of T2D. These findings can guide decision making regarding choice of bariatric operation.

PMID:
28236529
DOI:
10.1016/j.soard.2017.01.021
[Indexed for MEDLINE]

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