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Original Investigation
January 12, 2022

Medication Use for Obesity-Related Comorbidities After Sleeve Gastrectomy or Gastric Bypass

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
  • 2Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 3National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 4Veterans Affairs Ann Arbor, Ann Arbor, Michigan
  • 5Department of Surgery, Yale School of Medicine, New Haven, Connecticut
  • 6Kaiser Permanente Washington Health Research Institute, Seattle
  • 7Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
JAMA Surg. Published online January 12, 2022. doi:10.1001/jamasurg.2021.6898
Key Points

Question  What is the long-term incidence of medication discontinuation and restart associated with sleeve gastrectomy and gastric bypass in patients with obesity-related comorbidities?

Findings  In this comparative effectiveness research study of 95 405 patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass, gastric bypass was associated with a slightly higher incidence of discontinuing diabetes, hypertension, or hyperlipidemia medication up to 5 years after surgery, compared with sleeve gastrectomy. Patients who underwent gastric bypass also had a lower incidence of medication restart for all 3 medication classes.

Meaning  These findings suggest that, after bariatric surgery, patients who had gastric bypass may be more likely to remain free of obesity-related medications compared with those who underwent sleeve gastrectomy.

Abstract

Importance  Sleeve gastrectomy and gastric bypass are the most common bariatric surgical procedures in the world; however, their long-term medication discontinuation and comorbidity resolution remain unclear.

Objective  To compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications up to 5 years after sleeve gastrectomy or gastric bypass.

Design, Setting, and Participants  This comparative effectiveness research study of adult Medicare beneficiaries who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis used instrumental-variable survival analysis to estimate the cumulative incidence of medication discontinuation and restart. Data analyses were performed from February to June 2021.

Exposures  Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.

Main Outcomes and Measures  The primary outcome was discontinuation of diabetes, hypertension, and hyperlipidemia medication for any reason. Among patients who discontinued medication, the adjusted cumulative incidence of restarting medication was calculated up to 5 years after discontinuation.

Results  Of the 95 405 patients included, 71 348 (74.8%) were women and the mean (SD) age was 56.6 (11.8) years. Gastric bypass compared with sleeve gastrectomy was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30 588 patients with diabetes medication use and diagnosis at the time of surgery (74.7% [95% CI, 74.6%-74.9%] vs 72.0% [95% CI, 71.8%-72.2%]), 52 081 patients with antihypertensive medication use and diagnosis at the time of surgery (53.3% [95% CI, 53.2%-53.4%] vs 49.4% [95% CI, 49.3%-49.5%]), and 35 055 patients with lipid-lowering medication use and diagnosis at the time of surgery (64.6% [95% CI, 64.5%-64.8%] vs 61.2% [95% CI, 61.1%-61.3%]). Among the subset of patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. Specifically, the 5-year cumulative incidence of medication restart was lower after gastric bypass compared with sleeve gastrectomy among 19 599 patients who discontinued their diabetes medication after surgery (30.4% [95% CI, 30.2%-30.5%] vs 35.6% [95% CI, 35.4%-35.9%]), 21 611 patients who discontinued their antihypertensive medication after surgery (67.2% [95% CI, 66.9%-67.4%] vs 70.6% [95% CI, 70.3%-70.9%]), and 18 546 patients who discontinued their lipid-lowering medication after surgery (46.2% [95% CI, 46.2%-46.3%] vs 52.5% [95% CI, 52.2%-52.7%]).

Conclusions and Relevance  Findings of this study suggest that, compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication. Long-term trials are needed to explain the mechanisms and factors associated with differences in medication discontinuation and comorbidity resolution after bariatric surgery.

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