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Ann Intern Med. 2018 Dec 4;169(11):741-750. doi: 10.7326/M17-2786. Epub 2018 Oct 30.

Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study.

Author information

1
Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.).
2
Rockefeller University, New York, New York (A.E.).
3
The Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida (S.R.S.).
4
University of California, Irvine, School of Medicine, Irvine, California (A.O.O.).
5
Kaiser Permanente Southern California, Pasadena, California (S.M., K.J.C.).
6
Community Partners' Network, Nashville, Tennessee (N.W.).
7
University of Pittsburgh, Pittsburgh, Pennsylvania (A.C., K.M.M.).
8
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.).
9
Duke Clinical & Translational Science Institute, Durham, North Carolina (C.J.).
10
Jesse Brown VA Medical Center
11
COPD Foundation
12
University of Nebraska Medical Center
13
Vanderbilt University
14
Obesity Action Coalition
15
University of Pittsburgh Medical Center
16
Nationwide Children's Hospital
17
Boston Children's Hospital
18
University of California, Davis
19
Ochsner Surgical Weight Loss Center
20
Boston Medical Center/Boston University School of Medicine
21
Brigham and Women's Hospital
22
Smart Patients, Inc
23
Northwestern Medicine
24
Harvard Medical School and Harvard Pilgrim Health Care Institute
25
University of Pennsylvania
26
Lutheran Medical Center
27
Rockefeller University
28
Johns Hopkins University
29
University of Colorado, Denver, and Children's Hospital of Colorado
30
Cincinnati Children's Hospital Medical Center
31
Tulane University School of Public Health
32
Louisiana Public Health Research Institute
33
University of Illinois
34
University of Chicago
35
Loyola Medicine
36
Marshfield Clinic Research Institute
37
Kansas University Medical Center
38
University of Texas Southwestern
39
University of Wisconsin-Madison
40
University of North Carolina
41
Mount Sinai Health System
42
Weill Cornell Medical College
43
Montefiore Medical Center
44
University of Florida Health
45
Geisinger Health
46
Pennsylvania State University
47
Temple University
48
University of Utah
49
Kaiser Permanente Colorado
50
Kaiser Permanente Mid-Atlantic
51
Health Partners
52
Kaiser Permanente Northwest
53
University of California, Los Angeles
54
Baylor Scott & White
55
Wake Forest School of Medicine
56
Beth Israel Deaconess Medical Center
57
Kaiser Permanente Washington Health Research Institute
58
Florida Hospital
59
University of California, Irvine
60
Duke Clinical & Translational Science Institute
61
Community Partners' Network
62
Kaiser Permanente Southern California

Abstract

Background:

There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness.

Objective:

To compare weight loss and safety among bariatric procedures.

Design:

Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: NCT02741674).

Setting:

41 health systems in the National Patient-Centered Clinical Research Network.

Participants:

65 093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures.

Intervention:

32 208 Roux-en-Y gastric bypass (RYGB), 29 693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures.

Measurements:

Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events.

Results:

Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44 978 (84%), 20 783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI, 25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics.

Limitation:

Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data.

Conclusion:

Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed.

Primary Funding Source:

Patient-Centered Outcomes Research Institute.

PMID:
30383139
PMCID:
PMC6652193
DOI:
10.7326/M17-2786
[Indexed for MEDLINE]
Free PMC Article

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