Published in September/October Issue             

Hospital Quality and Medicare Expenditures for Bariatric Surgery in the United States
(Annals of Surgery)

A retrospective review examined the relationship between hospital outcomes and cost savings for patients undergoing bariatric surgery. The analysis, which included data from 38,374 Medicare beneficiaries who had surgery between 2011 and 2013, revealed a strong correlation between hospital complication rates and episode payments. Hospitals in the lowest quintile of complication rates had average total episode payments that were $1,321 less per patient than hospitals in the highest quintile ($11,112 vs. $12,433). Cost savings was more prominent among high-risk patients for total episode payments per patient between lowest and highest quintile hospitals ($12,960 vs. $15,120). In addition to total episode payment savings, hospitals with the lowest complication rates had lower costs for index hospitalization, readmissions, physician services, and post-discharge ancillary care compared with those with the highest rates.

The Impact of Different Surgical Techniques on Outcomes in Laparoscopic Sleeve Gastrectomies: The First Report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (Annals of Surgery)

This study assessed the impact of surgical techniques for staple line reinforcement (SLR) in laparoscopic sleeve gastrectomy (LSG) on 30-day complication rates and weight loss outcomes at 1 year. Using the MBSAQIP data registry, regression models were developed to analyze outcomes of 189,477 operations performed by 1,634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR. At the patient level, SLR was shown to be associated with higher leak rates (0.96% vs. 0.65%) and lower bleed rates (0.75% vs. 1.00%) compared to no SLR. At the surgeon level, leak rates remained significant, but bleeding events became non-significant. Based on the findings, the researchers concluded that a surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that minimize morbidity while maximizing clinical effectiveness.

Revision of Primary Sleeve Gastrectomy to Roux-en-Y Gastric Bypass, Indications and Outcomes from a High Volume Center (SOARD)

This study assessed the indications and outcomes of revision of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) in 48 patients at a single center hospital. Mean time to revision was 26 months and mean follow-up after revision was 20 months. Indications for revision were reflux (n= 14), inadequate weight loss (n=11), reflux and inadequate weight loss (n= 16), stricture (n= 4), chronic leak (n=1) and recurrent diabetes and reflux (n= 2). Reflux symptoms resolved in 96% of patients following revision and hiatal hernias were repaired in 50%. Percentage total weight loss at 3, 6, 12, 24 and 36 months was 9.0%, 12.9%, 15.7%, 13.3% and 6.5%, respectively. The overall complication rate was 31%. There were no mortalities. Researchers concluded that revision of SG to RYGB is a potentially effective means of treating SG complications, particularly reflux.

Effects of Bariatric Surgery on Gout Incidence in the Swedish Obese Subjects Study
(Annals of Rheumatic Disease)

To assess the long-term effect of bariatric surgery on the incidence of gout and hyperuricaemia, data was collected on 1,982 patients who had bariatric surgery and 1,999 obese controls from the Swedish Obesity Subjects (SOS) study. None of the subjects had gout at baseline. Median follow-up for the incidence of gout was about 19 years for both groups. The incidence of hyperuricaemia up to 20 years was examined in a subgroup of participants having baseline uric acid levels < 6.8 mg/dL. Bariatric surgery was associated with a reduced incidence of gout. The difference in absolute risk between groups was 3% at 15 years, and 32 patients needed to be treated with bariatric surgery to prevent an incident of gout. The effect of bariatric surgery on gout incidence was not influenced by baseline risk factors, including BMI. During follow-up, the surgery group had a lower incidence of hyperuricaemia. The difference in absolute risk between groups was 12% at 15 years, and 8 patients needed to be treated by bariatric surgery to prevent hyperuricaemia.