Assessing the real-world effect of laparoscopic bariatric surgery on the management of obesity-related comorbidities: A retrospective matched cohort study using a US Claims Database

Abstract

Aims: To evaluate the real-world effect of laparoscopic bariatric surgery, comprising adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), on the management of obesity-related comorbidities.

Methods: Patients who underwent laparoscopic bariatric surgeries between 2006 and 2013 were identified from the Optum Clinformatics administrative claims database. Those surgical patients were matched to medically managed patients (controls) on selected patient characteristics. Comorbidity management was assessed every 6 months up to 5 years after the surgery or an assigned index date for control subjects (follow-up), by evaluating the number of medication classes used to treat type 2 diabetes, hypertension and dyslipidaemia, as well as by evaluating the percentages of patients free of medications for these comorbidities.

Results: Patients who underwent LAGB (n = 4208, mean age 46.3 years), LRYGB (n = 4308, mean age 46.4 years) or LSG (n = 545, mean age 45.1 years) and patients in the control cohort (n = 9061, mean age 46.4 years) were similar in age, and the majority of patients in each study cohort were female (69.4%-75.8%). Compared with control subjects, patients who had laparoscopic bariatric surgery had significantly lower medication usage for obesity-related comorbidities, a trend that was evident at 6 months and that continued for up to 5 years of follow-up. Sub-analyses of changes in selected laboratory test values over follow-up corroborated the primary analyses.

Conclusions: Patients who had laparoscopic bariatric surgery used fewer medications for type 2 diabetes, hypertension and dyslipidaemia and had significant improvement in cardiometabolic risk factors for up to 5 years of follow-up compared with matched control subjects.

Keywords: bariatric surgery; cohort study; dyslipidaemia; hypertension; type 2 diabetes.