A study presented at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS) shows that sleeve gastrectomy, a newer type of bariatric surgery that reduces the size of the stomach by 60 to 80 percent, compares favorably to gastric bypass and adjustable gastric banding for complications and weight loss.
While study findings support sleeve gastrectomy as a safe and effective option for a primary bariatric procedure, the purpose of the study was to assist the Centers for Medicare and Medicaid Services (CMS) in their determination of coverage regarding sleeve gastrectomy by providing comparative evidence regarding bariatric surgery.
We will soon find out if the data is sufficient to convince CMS to provide coverage, as their final decision is expected at the end of the week.
For this study, researchers analyzed data from the Bariatric Outcomes Longitudinal Database (BOLD) for nearly 270,000 bariatric surgeries performed between 2007 and 2010. The procedures examined were laparoscopic gastric bypass (136,036), gastric banding (116,898), and sleeve gastrectomy (15,964).
Comparison of preoperative demographics:
- % of Female Patients: gastric bypass, 79%; gastric band, 78%; sleeve gastrectomy, 74%
- Average Age: gastric bypass, 45; gastric band, 46; sleeve gastrectomy, 45
- % Hypertension: gastric bypass, 58%; gastric band, 55%; sleeve gastrectomy, 54%
- % Diabetes: gastric bypass, 37%; gastric band, 28%; sleeve gastrectomy, 30%
- % Private Insurance: gastric bypass, 70%; gastric band, 68%; sleeve gastrectomy, 57%
Comparison of post-operative outcomes:
- % 30-day serious complications: 1.25% for gastric bypass, 0.25% for gastric band, and 0.96% for sleeve gastrectomy
- % 30-day reoperation: 2.73% for gastric bypass, 0.65% for gastric band, and 1.7% for sleeve gastrectomy
- % 30-day readmission: 4.62% for gastric bypass, 1.38% for gastric band, and 3.61% for sleeve gastrectomy
- % 30 day mortality: 0.14% for gastric bypass, 0.03% for gastric band, and 0.08% for sleeve gastrectomy
Change in BMI:
- Gastric bypass: Preoperative BMI was 47.7, at 12 months post-op BMI was 31.2
- Gastric band: Preoperative BMI was 45.1, at 12 months post-op BMI was 37.5
- Sleeve gastrectomy: Preoperative BMI was 47.5, at 12 months post-op BMI was 34.1
The researchers concluded that the “comparative safety and efficacy of the sleeve gastrectomy is between the two CMS-sanctioned bariatric procedures of gastric bypass and band” based on study results.
The study, “National Comparison of Bariatric Surgery Safety and Efficacy: Findings from the BOLD Database 2007-2010″ was published as an abstract (PL-104) and presented at the 2012 ASMBS conference. Researchers included: John Morton, MD, FASMBS from Stanford University, Stanford, CA; Bintu Sherif and Deborah Winegar, MD from Surgical Review Corporation, Raleigh, NC; Ninh Nguyen MD, FASMBS from UCI, Irvine, CA; Jaime Ponce, MD, FASMBS from Dalton Surgical Group, Dalton, GA; Robin Blackstone, MD, FASMBS, Scottsdale Bariatric Center, Scottsdale, AZ.