S. Pagkratis3, P. R. Armijo3, Y. Wang5, J. Mitchell4, V. Kothari3 3University Of Nebraska College Of Medicine,General Surgery,Omaha, NE, USA 4University Of Nebraska College Of Medicine,College Of Medicine,Omaha, NE, USA 5University Of Nebraska,College Of Public Health,Omaha, NE, USA
Introduction: Obesity is evolving into an epidemic in the United States. Bariatric surgery procedures are performed more frequently and patient’s access to bariatric centers is easier. Since the first weight loss operations were performed several decades ago, the utilization of each procedure has changed dramatically. Currently, sleeve gastrectomy (SG) and Roux-n-Y gastric bypass (RYGB) are the two most commonly procedures performed, whereas gastric bands and others are now rarely executed. Additionally, the implementation of new technology has shifted the approach to these procedures from open (O) to laparoscopic (L) and more recently to robotic assisted (RA). The aim of this study is to compare surgical outcomes between these two most popular procedures within all three approaches.
Methods: The UHC clinical database resource manager (CDB/RM) was queried for adult patients who underwent either open, laparoscopic or robotic RYGB or SG. Data for fourteen different surgical outcomes were collected and statistical analyses were conducted using IBM SPSS v23.0.0, with α=0.05.
Results:Between Jan/2013 and Sep/2015, a total of 27,901 patients underwent RYGB (O: 2,393, L: 23,902, RA: 1,606) and 41,318 patients had SG (O: 1,255, L: 37,766, RA: 2,297). For both procedures, the majority of patients had laparoscopic approach (RYGB: 85.7%, SG: 91.4%). Subsequently, for each approach, patients were stratified by severity on admission status (minor vs major severity), and 6 separate groups of patients occurred for each procedure. Analyses revealed interesting findings: minor severity L-RYGB patients more frequently suffered from aspiration pneumonia (L-RYGB:0.15%, L-SG:0.05%, p<0.001), GI hemorrhage (L-RYGB:0.43%, L-SG:0.05%, p<0.001), post-op infection (L-RYGB:0.13%, L-SG:0.05%, p=0.001), post-op shock (L-RYGB:0.14%, L-SG:0.08%, p=0.027), and death (L-RYGB:0.04%, L-SG:0.01%, p=0.008), compared to equal severity L-SG patients. Additionally, our data suggested that major severity patients who underwent O-RYGB and O-SG had surprisingly high mortality (O-RYGB:10.59%, O-SG:7.79%) and post-operative infection (O-RYGB:9.26%, O-SG:9.30%) rates, that reached 10%. Interestingly, for all patients who underwent RA approach, no statistically significant difference in outcomes was identified between SG and RYGB.
Conclusion:SG and RYGB are the most popular bariatric procedures performed nowadays with the laparoscopic approach being the predominant one. Analyzing data from a large national database from more than 69,000 patients reveals that patients who undergo L-RYGB have worse outcomes compared to L-SG patients. Additionally, our analyses suggest that when the RA approach is utilized this difference is eliminated. Moreover, open approach is associated with relatively higher mortality and post-operative infection risk. This information should be taken under consideration when we educate our patients and assist them to choose the procedure that is best for them.