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The Comparative Effectiveness of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding Procedures for the Treatment of Morbid Obesity

Carlin, Arthur M. MD*; Zeni, Telal M. MD; English, Wayne J. MD; Hawasli, Abdelkader A. MD§; Genaw, Jeffrey A. MD*; Krause, Kevin R. MD; Schram, Jon L. MD; Kole, Kerry L. DO§; Finks, Jonathan F. MD**; Birkmeyer, John D. MD**; Share, David MD**; Birkmeyer, Nancy J. O. PhD**For the Michigan Bariatric Surgery Collaborative

doi: 10.1097/SLA.0b013e3182879ded
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Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures.

Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity.

Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery.

Results: Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities.

Conclusions: With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

Citing limitations of published studies, payers have been reluctant to provide routine coverage for sleeve gastrectomy for the treatment of morbid obesity. Using data from a statewide, externally audited clinical registry, our study compares rates of complications, and weight loss, comorbidity remission, quality of life, and satisfaction for 3 years after bariatric surgery among nearly 9000 morbidly obese patients. We find that with better weight loss than adjustable gastric band and lower complication rates than gastric bypass, sleeve gastrectomy is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

*Department of Surgery, Henry Ford Health System, Detroit, MI

St. Mary Mercy Hospital, Livonia, MI

Marquette General Hospital, Marquette, MI

§St. John Providence Health System, St. Clair Shores, MI

William Beaumont Hospital, Royal Oak, MI

Spectrum Health, Grand Rapids, MI

**Value Partnerships Program, Blue Cross and Blue Shield of Michigan, Detroit, MI, and the Center for Healthcare Outcomes and Policy and Department of Surgery, University of Michigan, Ann Arbor, MI.

Reprints: Nancy J.O. Birkmeyer, PhD, Center for Healthcare Outcomes and Policy, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Bldg 520, Ann Arbor, MI 48109. E-mail: nbirkmey@med.umich.edu.

Disclosure: Dr N. Birkmeyer discloses research funding related to the Michigan Bariatric Surgery Collaborative to her institution from the Agency for Healthcare Research and Quality and from Blue Cross and Blue Shield of Michigan/Blue Care Network. Dr W. English discloses the following financial activities unrelated to this work: consulting for Surgical Review Corporation, being a paid speaker for the American Society for Metabolic and Bariatric Surgery, and travel/accommodations/meeting expenses with the American College of Surgeons and ReShape Medical. Dr Genaw discloses consulting for attorneys/legal forms for malpractice review unrelated to this work. Dr J. Birkmeyer has an equity interest in ArborMetrix, Inc, which provides software and services for profiling hospital quality and episode cost efficiency.

© 2013 by Lippincott Williams & Wilkins.