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An evaluation of bariatric surgery in all military treatment facilities

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Multiple bariatric databases have been formed, but there have been no comprehensive assessments of military treatment facilities (MTFs). MTFs have unique patients and coverage policies by Tricare insurance.

Methods

MHS Mart (M2) was used to review the outpatient medical record, AHLTA, from October 2013 to December 2018 for type of bariatric procedure, demographics, military-specific data, comorbidities, and complications, which were identified by ICD code and CPT code, including a robotic modifier. MTFs were classified by volume as high (HV) with > 50 cases annually, moderate (MV) with 25 to 50 cases, and low (LV) with < 25 cases, as well as by the presence of surgical residencies.

Results

Patients at MTFs were slightly younger and more female than by other database studies. The Army was the most common branch of service, and dependents of retirees were the most common beneficiary population. MTFs with residencies had slightly older patients and fewer Army patients. HV, MV, and LV MTFs had similar patients except for branch of service. Over time, the proportion of open gastric bypasses increased, biliopancreatic diversions with duodenal switches decreased, and robotic assistance increased 744%. MTFs with residencies performed more procedures than those without residencies, and with the exception of procedures utilizing robotic assistance, procedures were overall similar to those without residencies. HV MTFs performed most of the procedures annually, and their procedures were proportionately similar to MV and LV MTFs, with the exception of HV MTFs having a higher proportion of laparoscopic bypasses and robotic assistance.

Conclusion

MTFs largely perform similar procedures on similar patients relative to MBSAQIP and NSQIP studies. Robotic assistance increased significantly over time. Except for laparoscopic bypasses and procedures with robotic assistance, HV MTFs performed similar proportions of procedures to MV and LV MTFs. MTFs with residencies performed similar procedures to those without residencies.

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Acknowledgements

Study design and concept development by Byron Faler MD. IRB submission by Marcos Aranda MD. Data gathering and analysis by Jeffrey Ling MD, William Chang MD, and Marcos Aranda MD. Manuscript composition by Marcos Aranda MD and Byron Faler MD. Final approval of all components of the publication by Byron Faler MD. Additional assistance with statistical data analysis from Balakrishna Prasad PhD.

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  1. Dwight D Eisenhower Army Medical Center, 300 E. Hospital Rd, Fort Gordon, GA, 30905, USA

    Marcos Aranda, Jeffrey Ling, William Chang & Byron Faler

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  1. Marcos Aranda
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Correspondence to Marcos Aranda.

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The views expressed are those of the authors and do not reflect the official policy or position of the Army, the Department of Defense, or the US government. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Aranda, Dr. Ling, Dr. Chang, and Dr. Faler have no conflicts of interests or financial ties to disclose.

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Aranda, M., Ling, J., Chang, W. et al. An evaluation of bariatric surgery in all military treatment facilities. Surg Endosc 35, 5810–5815 (2021). https://doi.org/10.1007/s00464-020-08079-1

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