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Obesity Surgery

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01-11-2017 | Original Contributions

National Trends in Bariatric Surgery 2012–2015: Demographics, Procedure Selection, Readmissions, and Cost

Authors: Scott Kizy, Cyrus Jahansouz, Michael C. Downey, Nathanael Hevelone, Sayeed Ikramuddin, Daniel Leslie

Published in: Obesity Surgery | Issue 11/2017

Abstract

Background

Bariatric surgery is widely accepted as the best treatment for obesity and type 2 diabetes mellitus (T2DM). The Roux-en-Y gastric bypass (RYGB) and the sleeve gastrectomy (SG) have become the predominant bariatric procedures in the USA over the last several years, although the most recent trends in selection are unknown.

Objective

The objective of this study is to assess selection trends, readmission rates, and cost of bariatric procedures in the USA from 2012 to 2015.

Methods

We used the Premier database from 2012 to 2015 to examine trends in incidence of RYGB, adjustable gastric banding (LAGB), and SG; readmissions; and cost. Multivariate regression was performed to identify predictors of readmission.

Results

The proportion of SG went up from 38 to 63% while the RYGB decreased from 44 to 30% over this time period. LAGB has decreased in use from 13 to 2%. In comparison to RYGB, readmission was less likely for SG (OR 0.64), males (OR 0.91), and more likely for black race (OR 1.27). The overall proportion of patients seeking RYGB with type 2 diabetes was higher than with SG (36 versus 25%), but SG has now overtaken RYGB as the most common procedure among diabetics. The SG is less costly than RYGB ($11,183 versus $13,485).

Conclusions

There is a continued overall trend in the increased popularity of the SG and decreased utilization of the RYGB and LAGB, although growth of the SG appears to be slowing. This is also true among patients with type 2 diabetes mellitus. Regardless of surgery type, underinsured and African-American race were more likely to be readmitted.

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Ikramuddin S, Korner J, Lee W-J, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA [Internet]. 2013;309:2240–2249. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3954742&tool=pmcentrez&rendertype=abstract

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.CrossRefPubMedPubMedCentral

Schauer P, Bhatt D, Kirwan J, Wolski K, Brethauer S, Navaneethan S, et al. Bariatric surgery versus intensive medical therapy for diabetes. The New England journal of medicine [Internet]. 2014;371:680–682. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMc1407393%5Cnpapers2://publication/doi/10.1056/NEJMc1407393

Nguyen NT, Masoomi H, Magno CP, Nguyen XMT, Laugenour K, Lane J. Trends in use of bariatric surgery, 2003-2008. Journal of the American College of Surgeons [Internet]. Elsevier Inc.; 2011;213:261–266. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2011.04.030

Nguyen NT, Root J, Zainabadi K, Sabio A, Chalifoux S, Stevens CM, et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Archives of surgery (Chicago, Ill. : 1960) [Internet]. 2005;140:1198–1202; discussion 1203. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16365242

Regan JP, Inabnet WB, Gagner MPA. Early experience with two stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-superobese patient. Obes Surg. 2003;Dec;13:861–4.CrossRefPubMed

Varela JE. Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients. Jsls [Internet]. 2011;15:486–91. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340957/pdf/jls486.pdf CrossRef

Abraham A, Ikramuddin S, Jahansouz C, Arafat F, Hevelone N, Leslie D. Trends in bariatric surgery: procedure selection, revisional surgeries, and readmissions. Obesity surgery [Internet]. Obes Surg; 2016;26:1371–1377. Available from: http://dx.doi.org/10.1007/s11695-015-1974-2

Esteban Varela J, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surgery for Obesity and Related Diseases [Internet]. Elsevier; 2015;11:987–990. Available from: http://dx.doi.org/10.1016/j.soard.2015.02.008

10.

Lager CJ, Esfandiari NH, Subauste AR, Kraftson AT, Brown MB, Cassidy RB, et al. Roux-en-Y gastric bypass vs. sleeve gastrectomy: balancing the risks of surgery with the benefits of weight loss. Obesity surgery [Internet]. Obes Surg; 2016;1–8. Available from: http://dx.doi.org/10.1007/s11695-016-2265-2

11.

Billeter AT, Probst P, Fischer L, et al. Risk of malnutrition, trace metal, and vitamin deficiency post Roux-en-Y gastric bypass—a prospective study of 20 patients with BMI <35 kg/m2. Obes Surg. 2015;25:2125–34.CrossRefPubMed

12.

Weiner JP, Goodwin SM, Chang H-Y, et al. Impact of bariatric surgery on health care costs of obese persons. JAMA Surgery. 2013;148:555–62.CrossRefPubMed

13.

Reames BN, Finks JF, Bacal D, Carlin AM, Dimick JB. Changes in bariatric surgery procedure use in Michigan, 2006-2013. JAMA [Internet]. 2014;312:959. Available from: doi: 10.1001/jama.2014.7651

14.

Debs T, Petrucciani N, Kassir R, Iannelli A, Amor I Ben, Gugenheim J. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005–2014. Surgery for Obesity and Related Diseases. Elsevier; 2016;12:1602–1609.

15.

Lecube A, de Hollanda A, Calañas A, Vilarrasa N, Rubio MA, Breton I, et al. Trends in bariatric surgery in Spain in the twenty-first century: baseline results and 1-month follow up of the RICIBA, a National Registry. Obesity Surgery [Internet]. Obes Surg; 2016;26:1836–1842. Available from: http://dx.doi.org/10.1007/s11695-015-2001-3

16.

Hainer V, Toplak H, Mitrakou A. Treatment modalities of obesity: what fits whom? Diabetes care. 2008;31 Suppl 2.

17.

Carlin AM, Zeni TM, English WJ, Hawasli AA, Genaw JA, Krause KR, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Annals of surgery [Internet]. 2013;257:791–797. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23470577

18.

Young MT, Gebhart A, Phelan MJ, Nguyen NT. Use and outcomes of laparoscopic sleeve gastrectomy vs laparoscopic gastric bypass: analysis of the American college of Surgeons NSQIP. Journal of the American College of Surgeons [Internet]. American College of Surgeons; 2015;220:880–885. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2015.01.059

19.

Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues general recommendations for the prevention and treatment of nutritional deficiencies. Diabetes and Metabolism [Internet]. Elsevier; 2009;35:544–557. Available from: http://dx.doi.org/10.1016/S1262-3636(09)73464-0

20.

Aminian A, Brethauer SA, Andalib A, Punchai S, Mackey J, Rodriguez J, et al. Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Annals of surgery [Internet]. 2016;XX:674–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27433906

21.

Ignat M, Vix M, Imad I, D’Urso A, Perretta S, Marescaux J, et al. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. The British journal of surgery [Internet]. 2016; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27901287

22.

Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–85.PubMedPubMedCentral

23.

Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured?: long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258:628–37.PubMedPubMedCentral

Title: National Trends in Bariatric Surgery 2012–2015: Demographics, Procedure Selection, Readmissions, and Cost
Authors: Scott Kizy
Cyrus Jahansouz
Michael C. Downey
Nathanael Hevelone
Sayeed Ikramuddin
Daniel Leslie
Publication date: 01-11-2017
Publisher: Springer US
Published in: Obesity Surgery / Issue 11/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-2719-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

National Trends in Bariatric Surgery 2012–2015: Demographics, Procedure Selection, Readmissions, and Cost

Abstract

Background

Objective

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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