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Post-surgical interventions

More operations or interventions after gastric bypass than sleeve

The estimated, adjusted cumulative incidence rates of operation or intervention at five years were 8.94% for SG and 12.27% for RYGB
Revision appeared more common after SG compared with RYGB but the authors noted that the difference was not significant, for RYGB 2.8% underwent a revision by five years, compared with 4.0% for SG

A study involving tens of thousands of bariatric surgery patients found that RYGB patients were significantly more likely than sleeve gastrectomy (SG) patients to return to hospital in the years following surgery for an operation or intervention. According to the authors, the study is one of the largest bariatric surgery studies ever done and the first study of its size to focus on health problems years after the procedure.

Anita Courcoulas

"In bariatric surgery, there has been an explosion of data, but most focuses on positive outcomes," said lead author, Dr Anita Courcoulas, professor of surgery, University of Pittsburgh School of Medicine (UPMC), and chief of minimally invasive bariatric surgery. "This study is important because it includes adverse events people might be concerned about."

For the study, ‘Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study’, published in JAMA Surgery, researchers using data collected from the PCORnet Bariatric Study examined electronic medical records from 33,560 bariatric surgery patients across ten different medical centres from 2005-2015.

"It was critical to have so many sites participating because that helps make sure that our findings are relevant to patients from all around the country," said co-author, Dr David Arterburn, senior investigator, Kaiser Permanente Washington, and co-principal investigator of the PCORnet Bariatric Study.

The results revealed that 18,056 (54%) patients had a RYGB and 15,504 (46%) a SG. The study was predominantly female (80%), white (66%) with 26% of Hispanic ethnicity. The median follow-up for operation or intervention was 3.4 years for RYGB and 2.2 years for SG.

The investigators found that an operation or intervention was less likely for SG than for RYGB (p<0.001) and the estimated, adjusted cumulative incidence rates of operation or intervention at five years were 8.94% for SG and 12.27% for RYGB. Revision appeared more common after SG compared with RYGB but the authors noted that the difference was not significant, for RYGB 2.8% underwent a revision by five years, compared with 4.0% for SG.

In addition, hospitalisation was less likely for SG than for RYGB (p<0.001) and the five-year adjusted cumulative incidence rates were 32.79% for SG and 38.33% for RYGB. Endoscopy was less likely for SG than for RYGB (p<0.001) and the adjusted cumulative incidence rates at five years were 7.80% for SG and 15.83% for RYGB.

There were no differences in all-cause mortality between SG and RYGB after five years.

“This study showed that problems, including interventions, operations and hospitalisations, were relatively common after bariatric surgical procedures and were more often associated with RYGB than with SG,” the authors concluded. “The collection of data from mid-term to longer-term events was feasible and could be carried out effectively in large data sets linked to insurance claims and mortality data. This information, balanced with the weight loss and health outcome results from this study, will help inform procedure-specific decision-making for prospective patients and physicians.”

Courcoulas suspects the reason patients need more care in the years after gastric bypass is that it's a more complex surgery than sleeve gastrectomy, though she was quick to point out that procedures for positive health changes, such as hernia repair, also were included in the analysis.

Although the risks seem slightly higher with gastric bypass, the potential benefits are greater, too. An earlier paper using the same PCORnet dataset showed that gastric bypass resulted in significantly more weight loss than gastric sleeve.

Ultimately, the results of these studies could be used to help patients and health care providers make more informed decisions about the type of bariatric surgery to pursue.

"What we advocate is high-quality shared decision making between providers and patients," added Courcoulas. "It starts with a conversation about what their preferences and values are. Some people value low risk, some value high weight loss. It's important to have information on both sides of the risk-benefit equation."

To access this paper, please click here

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