Adults with severe obesity who underwent a bariatric procedure were more likely to sustain greater weight loss at 1, 3 and 5 years with Roux-en-Y gastric bypass vs. sleeve gastrectomy or adjustable gastric banding, although gastric bypass was associated with more severe adverse events vs. other procedures, according to analysis of data from more than three dozen health systems.
Despite a “rapid shift” in surgical procedures performed for weight loss, long-term data comparing the efficacy and safety of sleeve gastrectomy vs. Roux-en-Y gastric bypass vs. adjustable gastric banding are lacking, David Arterburn, MD, MPH, a general internist and health services researcher at Kaiser Permanente Washington Health Research Institute in Seattle, and colleagues wrote in the study background. Among 66 randomized controlled trials or observational studies directly comparing Roux-en-Y vs. sleeve gastrectomy, just 16 involved U.S. samples and only five had at least 5 years of follow-up.
“Thus, the long-term comparative effectiveness of [sleeve gastrectomy], [Roux-en-Y] and [adjustable gastric banding] is largely unknown, and there is no consensus in the medical community about the clinical utility of these procedures for weight loss, leading to unwarranted variation in insurance coverage and use of these procedures in the United States,” the researchers wrote.
In a retrospective, observational cohort study, Arterburn and colleagues analyzed data from 65,093 patients with BMI at least 35 kg/m² who underwent a bariatric procedure, using data from 41 health systems participating in the Patient-Centered Outcomes Research Network (PCORnet) Bariatric Study (74% white; 21% black; 21% Hispanic). Within the cohort, 32,208 patients underwent Roux-en-Y gastric bypass, 29,693 underwent sleeve gastrectomy and 3,192 underwent adjustable gastric banding procedures. Researchers assessed estimated percent total weight loss at 1, 3 and 5 years and 30-day rates of major adverse events.
The researchers found that 30-day rates for major adverse events were 5% for Roux-en-Y gastric bypass, 2.6% for sleeve gastrectomy and 2.9% for adjustable gastric banding. The researchers observed more adverse events with Roux-en-Y vs. sleeve gastrectomy (OR = 1.57; 95% CI, 1.4-1.77) and vs. gastric banding (OR = 1.66; 95% CI, 1.28-2.16); however, rates did not differ between gastric banding and sleeve gastrectomy.
One-year mean total weight loss for the three procedures was 31.2% for Roux-en-Y, 25.2% for sleeve gastrectomy and 13.7% for adjustable gastric banding.
At 5 years, patients in each group, on average, regained some weight, according to researchers. Despite this, mean total weight loss at 5 years remained higher for patients who underwent Roux-en-Y gastric bypass; mean total weight loss at 5 years was 25.5% for Roux-en-Y, 18.8% for sleeve gastrectomy and 11.7% for adjustable gastric banding. The sleeve gastrectomy group experienced greater total weight loss vs. the gastric banding group at 5 years (mean difference, 7.3 percentage points; 95% CI, 5.2-9.3).
Nearly all patients who underwent Roux-en-Y and sleeve gastrectomy achieved an estimated total weight loss greater than 5% at 1, 3 and 5 years, according to researchers, whereas patients who underwent Roux-en-Y were more likely to achieve total weight loss greater than 10%, 20% and 30% at all time points.
The researchers noted that patients with diabetes, those with a BMI less than 50 kg/m² or those aged at least 65 years, as well as black and Hispanic patients, lost less weight vs. patients without those characteristics.
“Health care providers, patients and policymakers can use these data to inform treatment and insurance coverage decisions,” the researchers wrote. “Not every patient with severe obesity will be interested in bariatric surgery, but all providers should incorporate a shared decision-making discussion of its potential role into their clinical practice.” – by Regina Schaffer
Disclosures: Arterburn reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.