What Were They Thinking???
Results Are In On Reoperative Bariatric Surgery

Published in September 2014 Issue             

A major new study finds if a patient undergoes a second bariatric operation because of weight regain or complications, their one-year weight loss is substantial, disease resolution for improvement is high, and the complication rate is low.

“These data fly in the face of insurers that claim there is little or uncertain benefit to a second bariatric operation and that it’s not safe,” said Ranjan Sudan, MD, Associate Professor of Surgery, Duke University School of Medicine, the study’s lead author. “Patients do benefit and they benefit significantly. There is no clinical justification for denying the surgery based on the data.”

The study was published online first in the September edition of the Journal of Gastrointestinal Surgery. Researchers analyzed the data of nearly 450,000 bariatric operations performed between 2007 and 2012, from the Bariatric Outcomes Longitudinal Database (BOLD).

According to the study, the reoperation rate was 6.3 percent, about 70 percent of these operations were corrective and about 30 percent were for conversions. Researchers compared the outcomes of primary operations to corrective and conversions and found them to relatively comparable:

There was a significant decline in patients taking medications for diabetes after surgery, despite the reason for the operation. Patients using diabetes medications declined by 72.5 percent after a primary operation, 68.6 after a conversion, 64.8 percent after a corrective operation. Significant declines were also seen in treatment for sleep apnea, high blood pressure and gastroesophageal reflux disease (GERD).

The study notes that coverage requests for reoperations due to partial treatment effect for weight loss or obesity-related diseases and conditions are frequently denied. Insurers have cited several factors for these denials including higher reported complications rates, uncertain benefits and patient noncompliance with prescribed diet and exercise regimens.

John Morton, MD

“Most of the data that the insurers were citing were single institution studies or anecdotal, and did not provide a clear picture of the risks and benefits of reoperations,” said John M. Morton, MD, a co-author of the study and ASMBS president-elect. “We are confident this new data will serve to correct misconceptions many have about reoperations.”

The new study was done after an ASMBS task force headed by Dr. Morton was formed in 2013 to look at the issue of reoperations and determine gaps in knowledge and data. The task force conducted a systemic review of the literature on reoperative bariatric surgery and “identified a paucity of high quality data.” This led to the analysis of the BOLD database and the study by Dr. Sudan, Dr. Morton, Dr. Ninh T. Nguyen, Dr. Matthew M. Hutter, Dr. Stacy A. Brethauer and Dr. Jaime Ponce.

"Bariatric surgery remains the most effective operation for severe obesity and related conditions,” said Dr. Morton. “But obesity is a chronic condition, some patients may have a partial response to treatment, just as we have seen with treatments for other chronic conditions. It doesn’t mean we give up or stop treating them. This new data suggests we can give these patients a second chance.”

Dr. Sudan noted that the reoperative data published in the Journal of Gastrointestinal Surgery study was provided to Blue Cross and Blue Shield of North Carolina (BCBSNC), which led to the insurer making its reoperation policy consistent with ASMBS guidelines and recommendations.