GRAPEVINE, TEX. — First data from the landmark Bariatric Outcomes Longitudinal Database show that two types of surgery—Roux-en-Y gastric bypass and gastric banding—account for 93% of all primary bariatric procedures performed at U.S. centers of excellence.
Among 57,918 bariatric surgery patients enrolled during the first 16 months of BOLD, 53.5% had a gastric bypass and 39.2% had a gastric banding procedure. Rounding out the top four most frequently performed primary operations were sleeve gastrectomy (2.3%) and biliopancreatic diversion/duodenal switch (1%), Dr. Eric J. DeMaria said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
All-cause mortality at 90 days in this huge series was just 0.112%, a result that underscores the high quality of outcomes achieved in ASMBS-designated centers of excellence, said Dr. DeMaria, professor of surgery at Duke University, Durham, N.C.
BOLD, the world's largest prospective clinical database for bariatric surgery, is enrolling about 2,700 patients per month.
The baseline BOLD data presented by Dr. DeMaria provide a close-up of contemporary bariatric surgery as conducted at 371 ASMBS-approved centers with 639 ASMBS-approved surgeons. Another 105 centers are provisionally approved.
Although it's far too early to draw conclusions about the relative effectiveness of the various procedures in maintaining weight loss, Dr. DeMaria presented data on key demographics and short-term outcomes. Some of the findings are as follows:
▸ The patients' average age was 46.6, and 79% were women. A total of 78% were white, 10% black, and 6% Hispanic.
▸ Mean preoperative body mass index was 46.5 kg/m
▸ Roux-en-Y gastric bypass was performed laparoscopically in 89% of cases, as were 3% of sleeve gastrectomies and two-thirds of biliopancreatic diversion/duodenal switches.
▸ Vertical gastric banding accounted for less than 1% of all gastric banding procedures in BOLD.
▸ Most patients received two forms of venous thromboembolism prophylaxis in-hospital, but 7% had none.
▸ Duration of surgery averaged 91 minutes, with 129 minutes of anesthesia, 41 mL of blood loss, and a 2.5-day length of hospital stay.
▸ Adverse events occurred prior to discharge in 3.6% of cases.
▸ With a maximum follow-up of 16 months, the percentage of patients experiencing one or more adverse events varied by procedure: gastric banding, 4%; sleeve gastrectomy, 10%; gastric bypass, 14%; and biliopancreatic diversion/duodenal switch, 25%.
The ambitious quality improvement project is “believed to be a model for other specialties,” Dr. DeMaria said.
He disclosed that he serves as unpaid chair of the research advisory committee of the Surgical Review Corp., a nonprofit company formed to run BOLD.
All-cause mortality at 90 days in this huge series was just 0.112%.
Source DR. DEMARIA