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A Surgical Inflection Point: Trends in Bariatric Surgery Procedures in the United States
*Rachel K Brickman1, *Sarah E Billmeier2, Gina L Adrales2
1Geisel School of Medicine at Dartmouth, Hanover, NH;2Dartmouth-Hitchcock Medical Center, Lebanon, NH
Objective. Examine national trends and geographic variation in bariatric surgery, 2012-2013.
Design. The Nationwide Inpatient Sample was used to identify the annual number of bariatric procedures performed using ICD-9 codes. The Behavioral Risk Factor Surveillance System survey was used to determine the population of bariatric surgery eligible patients.
Setting. Nine U.S. Census Divisions.
Patients. The eligible population included those with BMI ≥ 40, or BMI ≥ 35 with diabetes.
Main Outcome Measures. Differential rates of Laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), adjustable gastric bands and other primary bariatric procedures per 100k bariatric surgery eligible population.
Results. In 2012, 122,785 bariatric procedures were performed, representing a rate of 1096 procedures (range across divisions 803-1960) per 100k of surgery qualified morbidly obese. LRYGB comprised 50% of all inpatient procedures, and was the most common operation in all divisions except East and West South Central, where LSG was more frequent. The national proportion of LSG was 40%. In 2013 137,410 bariatric surgeries were performed, representing an incidence rate of 1164 procedures (range 905-2157) per 100k. The relative proportion of LRYGB fell to 39% overall, with an increase of LSG to 56% total. Only in the West North Central region did LRYGB remain the most common procedure; LSG prevailed in the remaining areas. New England had the largest increase in incident rate of LSG, from 491 in 2012 to 1023 per 100k in 2013.
Conclusions. In 2013, LSG surpassed LRYGB as the most common bariatric procedure performed in the U.S. Long-term comparative effectiveness data is needed to determine the relative rates of sustained weight loss, resolution of comorbidities and long-term complications for LSG and LRYGB.
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