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Obesity Surgery
Published in: Obesity Surgery 8/2016

01-08-2016 | Original Contributions

Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution

Authors: Dominic J. Vitello, Joy Beach-Bachmann, Joseph M. Vitello

Published in: Obesity Surgery | Issue 8/2016

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Abstract

Background

The purpose of this study was to compare the results and complications among obese veterans undergoing sleeve gastrectomy and gastric bypass at a low-volume center.

Materials and Methods

This is a retrospective review of bariatric procedures performed by a single surgeon from 2009–2013. Outcomes of interest were mortality, complications, and length of stay. Weight loss and comorbidity resolution were compared between sleeve gastrectomy (SG) and Roux-y gastric bypass (RYGB). Length of stay and distance traveled to receive services were analyzed. Distributed groups were compared with Student’s t test. Welch’s correction was used where variances were unequal via ANOVA. Complications were compared using Fisher’s exact test.

Results

Eighty-five patients (SG = 51, RYGB = 34) were analyzed. Postoperatively, patients were seen in clinic, contacted by phone or email, and their electronic health care records were reviewed. Average length of follow-up was 114.3 weeks. Mortality was 0 %. Complication rates were comparable between groups. The percent total weight loss was 22.6 % for the SG and 27.5 % for the RYGB (p = 0.02). The percent excess weight loss was 49 % for SG and 55 % for RYGB (p = 0.149). Percent excess body mass index (BMI) loss was 54 and 61 % (p = 0.197) for SG and RYGB, respectively. Comorbidity resolution was similar between groups except for diabetes which was superior for RYGB (p = 0.03). Veterans lived an average of 141.3 miles from our VA, and all 85 patients were able to be contacted for follow-up.

Conclusions

Despite long travel distances for high-risk veterans, bariatric surgery can be performed safely even at a low-volume VA hospital with acceptable morbidity and mortality and excellent follow-up. There was no difference in morbidity or mortality between patients undergoing SG vs RYGB.
Literature
1.
The Number of Veterans That Use VA Health Care Services: A Fact Sheet - zotero://attachment/47/. Retrieved April 17, 2015, from zotero://attachment/47/.
2.
3.
Almond N, Kahwati L, Kinsinger L, et al. Prevalence of overweight and obesity among U.S. military veterans. Mil Med. 2008;173(6):544–9.CrossRefPubMed
4.
Noël PH, Copeland LA, Pugh MJ, et al. Obesity diagnosis and care practices in the Veterans Health Administration. J Gen Intern Med. 2010;25(6):510–6.CrossRefPubMedPubMedCentral
5.
Das SR, Kinsinger LS, Yancy WS, et al. Obesity prevalence among veterans at Veterans Affairs medical facilities. Am J Prev Med. 2005;28(3):291–4.CrossRefPubMed
6.
Alami RS, Morton JM, Sanchez BR, et al. Laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs and high-volume academic facilities: a comparison of institutional outcomes. Am J Surg. 2005;190(5):821–5.CrossRefPubMed
7.
Safadi BY, Kieran JA, Hall RG, et al. Introducing laparoscopic Roux-en-Y gastric bypass at a Veterans Affairs medical facility. Am J Surg. 2004;188(5):606–10.CrossRefPubMed
8.
Huerta S, Kohan D, Siddiqui A, et al. Assessment of comorbid conditions in veteran patients after Roux-en-Y gastric bypass. Am J Surg. 2007;194(1):48–52.CrossRefPubMed
9.
10.
Livingston EH, Arterburn D, Schifftner TL, et al. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg. 2006;203(5):625–33.CrossRefPubMed
11.
Arterburn D, Livingston EH, Olsen MK, et al. Predictors of initial weight loss after gastric bypass in twelve veterans affairs medical centers. Obes Res Clin Pract. 2013;7:e367–76.CrossRefPubMed
12.
Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576–82.CrossRefPubMedPubMedCentral
13.
Fernandez AZ, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239(5):698–702. discussion 702–703.CrossRefPubMedPubMedCentral
14.
Fonseca ML, Smith ME, Klein RE, et al. The Department of Veterans Affairs medical care system and the people it serves. Med Care. 1996;34(3 Suppl):MS9–20.CrossRefPubMed
15.
16.
Agha Z, Lofgren RP, VanRuiswyk JV, et al. Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000;160(21):3252–7.CrossRefPubMed
17.
Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg. 2013;217(4):614–20.CrossRefPubMed
18.
Jennings N, Boyle M, Mahawar K, et al. The relationship of distance from the surgical center on attendance and weight loss after laparoscopic gastric bypass surgery in the United Kingdom. Clin Obes. 2013;3(6):180–4.CrossRefPubMed
19.
Kindel T, Martin E, Hungness E, et al. High failure rate of the laparoscopic-adjustable gastric band as a primary bariatric procedure. Surg Obes Relat Dis. 2014;10(6):1070–5.CrossRefPubMed
20.
Campos GM, Rabl C, Roll GR, et al. Better weight loss, resolution of diabetes, and quality of life for laparoscopic gastric bypass vs banding: results of a 2-cohort pair-matched study. Arch Surg. 2011;146(2):149–55.CrossRefPubMed
21.
De Gordejuela AGR, Pujol Gebelli J, García NV, et al. Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients? Surg Obes Relat Dis. 2011;7(4):506–9.CrossRefPubMed
22.
Lemanu DP, Singh PP, Rahman H, et al. Five-year results after laparoscopic sleeve gastrectomy: a prospective study. Surg Obes Relat Dis. 2015;11(3):518–24.
23.
Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83.CrossRefPubMed
24.
Sarela A, Dexter SP, O’Kane M, et al. Long-term follow-up after sleeve gastrectomy: 8–9 year results. Surg Obes Relat Dis. 2012;8(6):679–84.CrossRefPubMed
25.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.CrossRefPubMed
26.
Saul D, Stephens D, Hofstatter R, et al. Preliminary outcomes of laparoscopic sleeve gastrectomy in a veterans affairs medical center. Am J Surg. 2012;204(5):e1–6.CrossRefPubMed
27.
Eisenberg D, Bellatorre A, Bellatorre N. Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity. JSLS. 2013;17:63–7.CrossRefPubMedPubMedCentral
28.
Zellmer JD, Mathiason MA, Kallies KJ, et al. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–10. discussion 909–910.CrossRefPubMed
29.
Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. discussion 632–635.CrossRefPubMed
30.
Zhang Y, Ju W, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015;25(1):19–26.CrossRefPubMed
31.
Hauser DL, Titchner RL, Wilson MA, et al. Long-term outcomes of laparoscopic Roux-en-Y gastric bypass in US veterans. Obes Surg. 2010;20(3):283–9.CrossRefPubMed
32.
Arterburn D, Livingston EH, Schifftner T, et al. Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers. Arch Surg. 2009;144(10):914–20.CrossRefPubMed
33.
Nguyen NT, Paya M, Stevens M, et al. The relationship between hospital volume and outcomes in bariatric surgery at academic medical centers. Ann Surg. 2004;240(4):586–94.PubMedPubMedCentral
34.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed
35.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50. discussion 350–352.CrossRefPubMedPubMedCentral
36.
Todkar JS, Shah SS, Shah PS, et al. Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):142–5.CrossRefPubMed
37.
Li J-F, Lai D-D, Ni B, et al. Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Can J Surg. 2013;56(6):E158–64.CrossRefPubMedPubMedCentral
38.
Carter PR, LeBlanc KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(5):569–72.CrossRefPubMed
39.
DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg. 2014;149(4):328–34.CrossRefPubMed
Metadata
Title
Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution
Authors
Dominic J. Vitello
Joy Beach-Bachmann
Joseph M. Vitello
Publication date
01-08-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-2033-8

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