High Risks for Adverse Outcomes After Gastric Bypass Surgery Following Failed Gastric Banding

A Population-Based Trend Analysis of the United States

Mathias Worni, MD; Truls Østbye, MD, MPH PhD; Anand Shah, MD, MPH; Elias Carvalho, MSc; Inge M. Schudel, MD; Jin Hee Shin, MD, PhD; Ricardo Pietrobon, MD, PhD; Ulrich Guller, MD, MHS

Disclosures

Annals of Surgery. 2013;257(2):279-286. 

In This Article

Abstract and Introduction

Abstract

Objectives: The objectives of this investigation were to (1) compare short-term outcomes for patients undergoing primary gastric bypass surgery with those who had gastric bypass procedures performed as a rescue procedure after failed gastric banding and (2) study trends in the frequency of reoperations between 2005 and 2008 for patients who had prior gastric banding.

Background: The use of gastric banding to treat obesity has increased drastically in the United States. However, the frequency of reoperations related to gastric banding and associated short-term outcomes are unknown.

Methods: The Nationwide Inpatient Sample from 2005 to 2008 was used for this population-based study. Descriptive statistics as well as unadjusted and risk-adjusted generalized linear models were performed to assess adverse short-term outcomes.

Results: A total of 66,303 patients were included in the analysis, 63,171 (95.3%) underwent a primary gastric bypass procedure and 3132 patients (4.7%) underwent a gastric band-related reoperation. Patients undergoing a gastric bypass procedure concomitant with a band-related reoperation had more intraoperative complications [risk-adjusted odds ratio (OR): 2.3, P = 0.002] and postoperative complications (risk-adjusted OR: 8.0, P < 0.001), were at higher risk of reoperations/reinterventions (risk-adjusted OR: 6.0, P < 0.001), increased length of hospital stay (adjusted mean difference: 0.89 days, P < 0.001), and higher hospital charges (adjusted mean difference: $13,257, P < 0.001). The number of gastric band-related reoperations increased from 579 in 2005 to 1132 in 2008 (196%).

Conclusions: The number of reoperations after gastric banding is rapidly increasing in the United States. To our knowledge, this is the first population-based study providing strong evidence that patients undergoing gastric bypass procedure after failed gastric banding have more adverse outcomes than those undergoing gastric bypass alone. The broad indication for gastric banding should be reaffirmed for the US population.

Introduction

There has been a rapid increase in obesity in the United States over the last decade: in 2008, the prevalence of class II obesity (body mass index > 35 kg/m2) was 14.3%.[1,2] Notably, the use of laparoscopic gastric banding for the treatment of obese patients increased by more than 300% from 2004 to 2007.[1] Although several short-term benefits such as low perioperative morbidity and mortality, short hospital stays, and early return to work favor laparoscopic gastric banding over others,[1,3–6] numerous single-center series indicate that revisions may be necessary for 12% to 60% of patients whereas long-term complications range between 17% and 78%.[7–13] Nevertheless, limited observational data exist regarding trends in surgical revision after gastric banding.

Even though laparoscopic gastric banding for obesity was introduced in the early 1990s,[14] the Food and Drug Administration in the United States did not approve its use until 2001.[15] Excess weight loss after gastric banding procedures has been reported to vary between 31% and 62% after 5 years.[3,9,16–19] If major complications or excessive weight regain occur after gastric banding procedures, a revisional procedure is often performed. Many patients and surgeons prefer at this stage to convert the gastric banding to an alternative procedure, usually a gastric bypass.[20–22] However, whereas patients may experience weight loss after revisional gastric bypass surgery for failed gastric banding, an increase in surgery-related complications compared with primary gastric bypass procedures has been previously described.[23–26] Alternatives to revisional gastric bypass procedures as a rescue operation after failed gastric banding are also performed: gastric sleeve resection, duodenal switch, or biliopancreatic diversion whereas redo banding is no longer recommended because of its high secondary failure rate.[20,27,28] The enthusiasm for gastric banding procedures appears to be fading among many surgeons in Europe, but this trend has not yet been seen in the United States.[1,29]

In contrast to existing previous single-center experiences, the primary objective of this population-based study was to compare population-based short-term (inpatient) outcomes for patients undergoing primary gastric bypass surgery with those who had gastric bypass procedures performed as a rescue procedure for complications of gastric banding. The secondary objective was to study trends in the frequency of reoperations between 2005 and 2008 for patients who had prior gastric banding.

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