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Bariatric surgery: trends in utilization, complications, conversions and revisions
Justin L Hsu1, Sherin Ismail2, Maggie M Hodges3
1Department of Surgery, University of Toledo College of Medicine and Life Sciences, Mail Stop 1095, 3000 Arlington Ave, Toledo, OH, 43614, USA. Justin.Hsu@Utoledo.edu.
Surgical Endoscopy
|June 20, 2024
Summary
Sleeve gastrectomy (SG) utilization is declining due to higher rates of complications like reflux and hernias. Roux-en-Y gastric bypass (RYGB) remains a stable and important bariatric surgery option.
Area of Science:
- Bariatric surgery trends
- Surgical outcomes analysis
- Gastrointestinal surgery
Background:
- Sleeve gastrectomy (SG) gained popularity post-2010 but shows concerning rates of gastroesophageal reflux and conversion needs.
- Recent data indicate a potential shift away from SG due to these complications.
Purpose of the Study:
- To analyze recent trends in bariatric procedure utilization in the US.
- To evaluate complications and conversion rates associated with different bariatric procedures.
- To compare Sleeve Gastrectomy (SG) with Roux-en-Y Gastric Bypass (RYGB) outcomes.
Main Methods:
- Utilized the MarketScan Commercial Claims and Encounters database (2000-2020).
- Identified bariatric procedures, revisions, and conversions using CPT codes.
- Analyzed baseline comorbidities and postoperative complications via ICD-9-CM and ICD-10 codes.
- Employed stabilized inverse probability of treatment weighted Kaplan-Meier analysis for complication incidence.
Main Results:
- Sleeve gastrectomy (SG) volume declined starting in 2018, while Roux-en-Y gastric bypass (RYGB) remained steady.
- SG showed lower 1-year incidence of readmission, dehydration, nausea/vomiting, dysphagia, and GI hemorrhage compared to RYGB.
- SG had higher 1-year incidence of esophagogastroduodenoscopy, heartburn, gastritis, portal vein thrombosis, and hernias versus RYGB.
- Conversions from SG to RYGB exceeded re-sleeving procedures.
Conclusions:
- Bariatric procedure volume is declining, with decreasing SG and increasing RYGB proportions suggesting SG complications drive this trend.
- Roux-en-Y gastric bypass (RYGB) remains a critical and reliable option in bariatric surgery.
- Further investigation into SG-specific complications is warranted.
