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Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study

Educational Objective
To assess for up to 5 years the risks of intervention, operation, endoscopy, hospitalization, and mortality associated with Roux-en-Y gastric bypass or sleeve gastrectomy.
1 Credit CME
Key Points

Question  What are the risks of intervention, operation, endoscopy, hospitalization, and mortality up to 5 years associated with the 2 most common bariatric surgical procedures?

Findings  In this national, multicenter cohort study comparing outcomes of 33 560 adults undergoing either gastric bypass or sleeve gastrectomy, operations or interventions as well as hospitalization and endoscopy were more commonly associated with gastric bypass. There were no significant differences in mortality between the 2 surgical procedures through 5 years of follow-up.

Meaning  This information on 5-year bariatric surgical procedure outcomes helps to inform procedure-specific decision-making for prospective patients with severe obesity and their physicians.

Abstract

Importance  Additional data comparing longer-term problems associated with various bariatric surgical procedures are needed for shared decision-making.

Objective  To compare the risks of intervention, operation, endoscopy, hospitalization, and mortality up to 5 years after 2 bariatric surgical procedures.

Design, Setting, and Participants  Adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2005, and September 30, 2015, within the National Patient-Centered Clinical Research Network. Data from 33 560 adults at 10 centers within 4 clinical data research networks were included in this cohort study. Information was extracted from electronic health records using a common data model and linked to insurance claims and mortality indices. Analyses were conducted from January 2018 through October 2019.

Exposures  Bariatric surgical procedures.

Main Outcomes and Measures  The primary outcome was time until operation or intervention. Secondary outcomes included endoscopy, hospitalization, and mortality rates.

Results  Of 33 560 adults, 18 056 (54%) underwent RYGB, and 15 504 (46%) underwent SG. The median (interquartile range) follow-up for operation or intervention was 3.4 (1.6-5.0) years for RYGB and 2.2 (0.9-3.6) years for SG. The overall mean (SD) patient age was 45.0 (11.5) years, and the overall mean (SD) patient body mass index was 49.1 (7.9). The cohort was composed predominantly of women (80%) and white individuals (66%), with 26% of Hispanic ethnicity. Operation or intervention was less likely for SG than for RYGB (hazard ratio, 0.72; 95% CI, 0.65-0.79; P < .001). The estimated, adjusted cumulative incidence rates of operation or intervention at 5 years were 8.94% (95% CI, 8.23%-9.65%) for SG and 12.27% (95% CI, 11.49%-13.05%) for RYGB. Hospitalization was less likely for SG than for RYGB (hazard ratio, 0.82; 95% CI, 0.78-0.87; P < .001), and the 5-year adjusted cumulative incidence rates were 32.79% (95% CI, 31.62%-33.94%) for SG and 38.33% (95% CI, 37.17%-39.46%) for RYGB. Endoscopy was less likely for SG than for RYGB (hazard ratio, 0.47; 95% CI, 0.43-0.52; P < .001), and the adjusted cumulative incidence rates at 5 years were 7.80% (95% CI, 7.15%-8.43%) for SG and 15.83% (95% CI, 14.94%-16.71%) for RYGB. There were no differences in all-cause mortality between SG and RYGB.

Conclusions and Relevance  Interventions, operations, and hospitalizations were relatively common after bariatric surgical procedures and were more often associated with RYGB than SG.

Trial Registration  ClinicalTrials.gov identifier: NCT02741674

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 9, 2019.

Published Online: January 15, 2020. doi:10.1001/jamasurg.2019.5470

Correction: This article was corrected on March 18, 2020, to remove an open access license.

Corresponding Author: Anita Courcoulas, MD, Department of Surgery, University of Pittsburgh Medical Center, 3380 Boulevard of the Allies, Ste 390, Pittsburgh, PA 15213 (courcoulasap@upmc.edu).

Author Contributions: Drs Courcoulas and Coley had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Courcoulas, Coley, Clark, McBride, Cirelli, McTigue, Arterburn, Coleman, Anau, Janning, Williams, Horgan, Tavakkoli.

Acquisition, analysis, or interpretation of data: Courcoulas, Coley, Clark, McBride, McTigue, Arterburn, Coleman, Wellman, Anau, Toh, Cook, Sturtevant, Horgan, Tavakkoli.

Drafting of the manuscript: Courcoulas, Coley, Arterburn, Janning, Tavakkoli.

Critical revision of the manuscript for important intellectual content: Coley, Clark, McBride, Cirelli, McTigue, Arterburn, Coleman, Wellman, Anau, Toh, Cook, Williams, Sturtevant, Horgan, Tavakkoli.

Statistical analysis: Coley, Wellman, Toh, Cook.

Obtained funding: McTigue, Arterburn, Coleman, Anau, Tavakkoli.

Administrative, technical, or material support: Courcoulas, McBride, Coleman, Anau, Sturtevant, Horgan.

Supervision: Arterburn, Sturtevant.

Conflict of Interest Disclosures: Dr Courcoulas reported receiving grants from Allurion Technologies outside the submitted work. Dr Arterburn reported receiving grants from the National Institutes of Health and nonfinancial support from IFSO Latin America Chapter outside the submitted work. Dr Coleman reported receiving grants from the National Institutes of Health and from the US Food and Drug Administration outside the submitted work. No other disclosures were reported.

Funding/Support: This study was funded by the Patient-Centered Outcomes Research Institute via contract OBS-1505-30683.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The PCORnet Bariatric Study Collaborative members are Michelle R. Lent, PhD, Geisinger, Danville, Pennsylvania; David G. Schlundt, PhD, Vanderbilt University, Nashville, Tennessee; Meredith C. Duke, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Steven R. Smith, MD, AdventHealth Translation Research Institute, Orlando, Florida; Andrew O. Odegaard, PhD, MPH, University of California, Irvine; Rosalinde Saizan, BSN, RN, CBN. LCMCHealth, University Medical Center, New Orleans, Louisiana; Nirav K. Desai, MD, Boston Children’s Hospital, Boston, Massachusetts; Stavra A. Xanthakos, MD, Cincinnati Children’s Medical Center, Cincinnati, Ohio; Laura J. Rasmussen Torvik, PhD, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Marc P. Michalsky, MD, Nationwide Children’s Hospital, Columbus, Ohio; Matthew F. Daley, MD, Institute for Health Research, Kaiser Permanente, Denver, Colorado; Gabrielle Purcell, MPH, University of California, San Diego; Julie Tice, MS, Hershey, Pennsylvania; Sameer Murali, MD, Southern California Permanente Medical Group, Fontana; Ana Emiliano, MD, Columbia University, New York, New York; Caroline M. Apovian, MD, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts; Cynthia A. Blalock, MSN, Vanderbilt University Medical Center, Nashville, Tennessee; Elisha Malanga, BS, COPD Foundation, Miami, Florida; Elizabeth Nauman, MPH, PhD, Louisiana Public Health Institute, New Orleans, Louisiana; Jay R. Desai, PhD, MPH, HealthPartners Institute, Bloomington, Minnesota; Joseph Nadglowski, BS, Obesity Action Coalition, Tampa, Florida; John H. Holmes, PhD, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Joseph Vitello, MD, Jesse Brown VA Medical Center, Chicago, Illinois; Michael A. Horberg, MD, MAS, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland; Robert T. Greenlee, PhD, Marshfield Clinic Research Institute, Marshfield, Wisconsin; Stephanie L. Fitzpatrick, PhD, Kaiser Permanente Center for Health Research, Portland, Oregon; Roni Zeiger, MD, Facebook, Inc, Mountain View, California; Tammy St Clair, LMSW, Licensed Master Social Worker, New York, New York; Thomas Inge, MD, PhD, Children’s Hospital Colorado, University of Colorado, Denver, Aurora, Colorado; James C. McClay, MD, and Corrigan L. McBride, MD, University of Nebraska Medical Center, Omaha; Jefferey S. Brown, PhD, Sengwee Toh, ScD, Jessica L. Sturtevant, MS, and Casie Horgan, MPH, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts; Anita Courcoulas, MD, and Kathleen McTigue, MD, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Jeanne M. Clark, MD, Johns Hopkins University and Health Plan, Baltimore, Maryland; R. Yates Coley, PhD, David Arterburn, MD, Robert Wellman, MS, Jane Anau, BS, and Andrea J. Cook, PhD, Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Elizabeth Cirelli, MSN, and Ali Tavakkoli, MD, Brigham and Women’s Hospital, Boston, Massachusetts; Karen J. Coleman, PhD, Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California; Cheri D. Janning, MS, Duke Clinical & Translational Science Institute, Durham, North Carolina; and Neely Williams, MDiv, Community Partners’ Network, Nashville, Tennessee.

Additional Information: Dr Arterburn, who is the principal investigator, and the writing group of study investigators are responsible for the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.

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