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High Risks for Adverse Outcomes After Gastric Bypass Surgery Following Failed Gastric Banding: A Population-Based Trend Analysis of the United States

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

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182683037
Original Articles
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.

In Brief

Using the Nationwide Inpatient Sample, we demonstrate an increasing trend in reoperations after failed gastric banding and show that patients undergoing laparoscopic gastric bypass surgery after failed gastric banding have more adverse outcomes than those undergoing primary gastric bypass surgery. Indications for gastric banding in the United States must be reaffirmed.

Author Information

*Research on Research Group, Department of Surgery, Duke University Medical Center, Durham, NC

Department of Visceral Surgery and Medicine, Inselspital, University of Berne, Switzerland

Department of Community and Family Medicine, Duke University Medical Center, Durham, NC; and

§Department of Family Medicine, College of Medicine, The Catholic University of Korea, Seoul, South of Korea.

Reprints: Ulrich Guller, MD, MHS, Department of Visceral Surgery and Medicine, Inselspital, University of Berne, 3010 Berne, Switzerland. E-mail: ulrich.guller@gmail.com.

Disclosure: This work was supported in part by grants PBBEP3-131567 (MW) and PBBEP3-134913 (IS) from the Swiss National Science Foundation. The authors have no other potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

© 2013 Lippincott Williams & Wilkins, Inc.