1. Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study
- Author
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Cheri Janning, Jane Anau, Ana Emiliano, R. Yates Coley, Sengwee Toh, Anita P. Courcoulas, Robert J. Wellman, Casie Horgan, Andrea J. Cook, PCORnet Bariatric Study Collaborative, Andrew O. Odegaard, Neely Williams, Roy Pardee, Sameer B. Murali, Steven R. Smith, Karen J. Coleman, David Arterburn, Kathleen M. McTigue, and Jessica L. Sturtevant
- Subjects
Male ,Comparative Effectiveness Research ,medicine.medical_treatment ,Bariatric Surgery ,Medical and Health Sciences ,0302 clinical medicine ,Postoperative Complications ,Weight loss ,Medicine ,PCORnet Bariatric Study Collaborative ,030212 general & internal medicine ,Morbid ,General Medicine ,Middle Aged ,Obesity, Morbid ,Female ,Patient Safety ,medicine.symptom ,Cohort study ,Adult ,medicine.medical_specialty ,Sleeve gastrectomy ,Gastroplasty ,Clinical Trials and Supportive Activities ,Gastric Bypass ,030209 endocrinology & metabolism ,03 medical and health sciences ,Young Adult ,Gastrectomy ,Clinical Research ,Internal medicine ,General & Internal Medicine ,Weight Loss ,Internal Medicine ,Humans ,Obesity ,Adverse effect ,Retrospective Studies ,Aged ,Nutrition ,business.industry ,Prevention ,Retrospective cohort study ,medicine.disease ,Good Health and Well Being ,Laparoscopy ,Outcomes research ,business ,Digestive Diseases ,Body mass index ,Follow-Up Studies - Abstract
Background There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness. Objective To compare weight loss and safety among bariatric procedures. Design Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: NCT02741674). Setting 41 health systems in the National Patient-Centered Clinical Research Network. Participants 65 093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures. Intervention 32 208 Roux-en-Y gastric bypass (RYGB), 29 693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures. Measurements Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events. Results Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44 978 (84%), 20 783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI, 25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics. Limitation Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data. Conclusion Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed. Primary funding source Patient-Centered Outcomes Research Institute.
- Published
- 2018