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. 2024 Aug;38(8):4613-4623.
doi: 10.1007/s00464-024-10985-7. Epub 2024 Jun 20.

Bariatric surgery: trends in utilization, complications, conversions and revisions

Justin L Hsu  1 , Sherin Ismail  2 , Maggie M Hodges  3 , Chris B Agala  3 , Timothy M Farrell  3
Affiliations

Bariatric surgery: trends in utilization, complications, conversions and revisions

Justin L Hsu et al. Surg Endosc. 2024 Aug.

Abstract

Background: Sleeve gastrectomy (SG) increased in popularity after 2010 but recent data suggest it has concerning rates of gastroesophageal reflux and need for conversions. This study aims to evaluate recent trends in the utilization of bariatric procedures, associated complications, and conversions using an administrative claims database in the United States.

Methods: We included adults who had bariatric procedures from 2000 to 2020 with continuous enrollment for at least 6 months in the MarketScan Commercial Claims and Encounters database. Index bariatric procedures and subsequent revisions or conversions were identified using CPT codes. Baseline comorbidities and postoperative complications were identified with ICD-9-CM and ICD-10 codes. Cumulative incidences of complications were estimated at 30-days, 6-months, and 1-year and compared with stabilized inverse probability of treatment weighted Kaplan-Meier analysis.

Results: We identified 349,411 bariatric procedures and 5521 conversions or revisions. The sampled SG volume appeared to begin declining in 2018 while Roux-en-Y gastric bypass (RYGB) remained steady. Compared to RYGB, SG was associated with lower 1-year incidence [aHR, (95% CIs)] for 30-days readmission [0.65, (0.64-0.68)], dehydration [0.75, (0.73-0.78)], nausea or vomiting [0.70, (0.69-0.72)], dysphagia [0.55, (0.53-0.57)], and gastrointestinal hemorrhage [0.43, (0.40-0.46)]. Compared to RYGB, SG was associated with higher 1-year incidence [aHR, (95% CIs)] of esophagogastroduodenoscopy [1.13, (1.11-1.15)], heartburn [1.38, (1.28-1.49)], gastritis [4.28, (4.14-4.44)], portal vein thrombosis [3.93, (2.82-5.48)], and hernias of all types [1.36, (1.34-1.39)]. There were more conversions from SG to RYGB than re-sleeving procedures. SG had a significantly lower 1-year incidence of other non-revisional surgical interventions when compared to RYGB.

Conclusions: The overall volume of bariatric procedures within the claims database appeared to be declining over the last 10 years. The decreasing proportion of SG and the increasing proportion of RYGB suggest the specific complications of SG may be driving this trend. Clearly, RYGB should remain an important tool in the bariatric surgeon's armamentarium.

Keywords: Bariatric surgery; Duodenal switch; Gastric bypass; Morbid obesity; Sleeve gastrectomy; Weight loss.

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Conflict of interest statement

Drs. Justin Hsu, Sherin Ismail, Maggie Hodges, Chris Agala, and Timothy Farrell have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Trend of bariatric surgery 2000–2020, in percentage of total sample cohort. Overall trend of open roux-en-y gastric bypass (RYGB), laparoscopic RYGB, sleeve gastrectomy (SG), laparoscopic adjustable gastric banding (AGD), vertical banded gastroplasty (VBG), and biliopancreatic diversion with duodenal switch (BPD/DS) from 2000 to 2020 in terms of percentage of total sample cohort
Fig. 2
Fig. 2
SG and laparoscopic RYGB sample cohort trend 2004–2020. Overall quarterly and yearly trend of laparoscopic roux-en-y gastric bypass (RYGB) and sleeve gastrectomy (SG) in terms of sample volume
See this image and copyright information in PMC

References

    1. Hales CM, Carroll MD, Fryar CD, Ogden CL (2020) Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief 360:1–8 - PubMed
    1. Tsai AG, Williamson DF, Glick HA (2011) Direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obes Rev 12(1):50–61. 10.1111/j.1467-789X.2009.00708.x 10.1111/j.1467-789X.2009.00708.x - DOI - PMC - PubMed
    1. Waters H, Graf M (2018) America’s obesity crisis: the health and economic costs of excess weight [monograph on the internet]. Milken Institute, Santa Monica
    1. Chung AY, Strassle PD, Schlottmann F, Patti MG, Duke MC, Farrell TM (2019) Trends in utilization and relative complication rates of bariatric procedures. J Gastrointest Surg 23(7):1362–1372. 10.1007/s11605-018-3951-2 10.1007/s11605-018-3951-2 - DOI - PubMed
    1. English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, Morton JM (2020) American society for metabolic and bariatric surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis 16(4):457–463. 10.1016/j.soard.2019.12.022 10.1016/j.soard.2019.12.022 - DOI - PubMed

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