AHRQ Study Finds Benefits and Risks in Two Types of Bariatric Surgery

An AHRQ-funded study published online October 29 in the journal JAMA Surgery revealed that two techniques for performing bariatric surgery had differing benefits and risks. According to the study and abstract, which compared gastric banding and bypass, bypass resulted in much greater weight loss and fewer reoperations but was linked to more risk of complications than was banding. A team of researchers at Group Health Research Institute in Seattle studied nearly 7,500 patients from 10 U.S. health care systems who had laparoscopic bariatric surgery between 2005 and 2009 and were followed through 2010. The authors suggested that patients need to have informed discussions with their doctors about which type of surgery suits them best, based on what matters most to them as individuals. The study is titled, “Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding versus Laparoscopic Gastric Bypass.”

Comparative Effectiveness of Laparoscopic Adjustable Gastric Banding vs Laparoscopic Gastric Bypass ONLINE FIRST

David Arterburn, MD, MPH1; J. David Powers, MS2; Sengwee Toh, ScD3; Sarit Polsky, MD, MPH4; Melissa G. Butler, PharmD, MPH5; J. Dickman Portz, PhD2; William T. Donahoo, MD4,6; Lisa Herrinton, PhD7; Rebecca J. Williams, DrPH, MPH8; V. Vijayadeva, PhD, MBBS, MPH9; David Fisher, MD10; Elizabeth A. Bayliss, MD, MSPH2

[+] Author Affiliations

JAMA Surg. Published online October 29, 2014. doi:10.1001/jamasurg.2014.1674

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ABSTRACT

Importance Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (AGB) are 2 of the most commonly performed bariatric procedures worldwide. However, few large, multisite studies have directly compared the benefits and harms of these procedures.

Objective To compare the effect of laparoscopic RYGB vs AGB on short- and long-term health outcomes.

Design, Setting, and Participants A retrospective cohort study of 7457 individuals 21 years or older who underwent laparoscopic bariatric surgery from January 1, 2005, through December 31, 2009, with follow-up through December 31, 2010. All individuals were participants in the Scalable Partnering Network, a network of 10 demographically and geographically distributed health care systems in the United States.

Main Outcomes and Measures The primary outcomes were (1) change in body mass index (BMI), (2) a composite end point of 30-day rate of major adverse outcomes (death, venous thromboembolism, subsequent intervention, and failure to discharge from the hospital), (3) subsequent hospitalization, and (4) subsequent intervention.

Results We identified 7457 patients who underwent laparoscopic AGB or RYGB procedures with a median follow-up time of 2.3 years (maximum, 6 years). The mean maximum BMI (calculated as weight in kilograms divided by height in meters squared) loss was 8.0 (95% CI, 7.8-8.3) for AGB patients and 14.8 (95% CI, 14.6-14.9) for RYGB patients (P < .001). In propensity score–adjusted models, the hazard ratio for AGB vs RYGB patients experiencing any 30-day major adverse event was 0.46 (95% CI, 0.27-0.80; P = .006). The hazard ratios comparing AGB vs RYGB patients experiencing subsequent intervention and hospitalization were 3.31 (95% CI, 2.65-4.14; P < .001) and 0.73 (95% CI, 0.61-0.88; P < .001), respectively.

Conclusions and Relevance In this large bariatric cohort from 10 health care systems, we found that RYGB resulted in much greater weight loss than AGB but had a higher risk of short-term complications and long-term subsequent hospitalizations. On the other hand, RYGB patients had a lower risk of long-term subsequent intervention procedures than AGB patients. Bariatric surgery candidates should be well informed of these benefits and risks when they make their decisions about treatment.