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    Original Investigation
    January 15, 2020

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

    Author Affiliations
    • 1Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 2Kaiser Permanente Washington Health Research Institute, Seattle, Washington
    • 3General Internal Medicine, Johns Hopkins University and Health Plan, Baltimore, Maryland
    • 4Department of Surgery, University of Nebraska Medical Center, Omaha
    • 5Department of Nursing, Brigham and Women’s Hospital, Boston, Massachusetts
    • 6Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 7Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 8Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
    • 9Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
    • 10Duke Clinical Translational Science Institute, Duke University, Durham, North Carolina
    • 11Community Partners’ Network, Nashville, Tennessee
    • 12Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
    JAMA Surg. Published online January 15, 2020. doi:10.1001/jamasurg.2019.5470
    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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