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An Evaluation of the Modern North American Bariatric Surgery Landscape: Current Trends and Predictors of Procedure Selection

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Abstract

Purpose

The last 5 years have produced a dramatic transformation in the landscape of bariatric and metabolic surgery. Yet, while the landscape of bariatric procedures is changing, little is known about these trends or which factors are responsible for their evolution.

Methods

All primary elective laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) cases were extracted from the comprehensive Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2018.

Results

A total of 590,971 patients were identified, with 79.6% being female. Overall, 73.4% of patients underwent LSG. The mean age was 44.5 ± 12.0 years and mean BMI was 45.3 ± 7.9 kg/m2. An increase in proportion of LSG cases was observed and associated with a decrease in LRYGB cases from 2015 to 2018. Multivariable analysis identified dialysis dependence as the greatest predictor of LSG (OR 2.67; 95% CI 2.34–3.04), whereas insulin-dependent diabetes (OR 2.27; 95% CI 2.23–2.32) and gastroesophageal reflux disease (OR 1.52; 95% CI 1.51–1.55) were the two greatest predictors of LRYGB, respectively. Patients offered LSG in 2018 had a near 1.3-fold increase in odds of receiving sleeve gastrectomy vs. those offered surgery in 2015.

Conclusion

The overall numbers of bariatric cases have increased from 2015 to 2018 and are associated with an increase in proportion of LSG cases and a decrease in proportion of LRYGB cases over time. Factors other than patient comorbidities alone are responsible for the current trends and modern landscape of bariatric surgery.

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Acknowledgments

The authors would like to thank the Center for the Advancement of Minimally Invasive Surgery (CAMIS).

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

    Valentin Mocanu, Jerry T. Dang & Warren Sun

  2. Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada

    Daniel W. Birch, Shahzeer Karmali & Noah J. Switzer

Authors
  1. Valentin Mocanu
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  2. Jerry T. Dang
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Correspondence to Valentin Mocanu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this was a retrospective study, formal consent is not required.

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Mocanu, V., Dang, J.T., Sun, W. et al. An Evaluation of the Modern North American Bariatric Surgery Landscape: Current Trends and Predictors of Procedure Selection. OBES SURG 30, 3064–3072 (2020). https://doi.org/10.1007/s11695-020-04667-1

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  • DOI: https://doi.org/10.1007/s11695-020-04667-1

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