title: Quality and safety in obesity surgery-15 years of Roux-en-Y gastric bypass outcomes from a longitudinal database.
abstract: BACKGROUND
  Most population-based studies lack long-term data, making the reporting of true mortality and outcome rates difficult. An accurate estimate of these rates in a high-risk population is critical for obtaining informed consent, especially for an elective procedure such as Roux-en-Y gastric bypass (RYGB).
  
  
  OBJECTIVE
  To examine the longitudinal outcomes of RYGB.
  
  
  METHODS
  The California Office of Statewide Health Planning and Development (OSHPD) longitudinal database.
  
  
  METHODS
  The OSHPD longitudinal database was queried for patients who underwent RYGB between 1995 and 2009. The primary outcome was mortality rates at 1, 5, and 10 years. Secondary outcomes were marginal ulcer and reoperation. The Cox hazard proportional analysis was used to determine adjusted survival and long-term outcomes for laparoscopic RYGB compared with open RYGB.
  
  
  RESULTS
  The study included 129,432 RYGB patients. Rates of laparoscopy increased from 3% to 35% from 1995 to 2004 and then steeply increased to 80% in 2005 and to 93% in 2009. Overall mortality rate at 1, 5, and 10 years was 2.2%, 4.4%, and 8.1%, respectively; the rates of marginal ulcer were .3%, .7%, and 1%, respectively; and the reoperation rates were .3%, .8%, and 1.2%, respectively. Predictors of poor outcomes were male gender, age, smoking, alcohol, Medicare, Medi-Cal insurance, and Asian or Native American race. The laparoscopic approach was protective against death (hazard ratio [HR] 95% confidence interval [95%CI]: .63[.58-.69]) and long-term complications (HR .78[.72-.85]).
  
  
  CONCLUSIONS
  This longitudinal population study showed high rates of mortality following RYGB, with improved long-term outcomes when the laparoscopic approach was used.
authors.affiliation: University of California, San Diego, Department of Surgery, San Diego, California. Electronic address: weiss@ucsd.edu.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Weiss
authors.affiliation: University of California, San Diego, Department of Surgery, San Diego, California.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Parina
authors.affiliation: University of California, San Diego, Department of Surgery, San Diego, California.
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.affiliation: State University of New York Stonybrook, Department of Surgery, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Massachusetts General, Department of Surgery, Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: University of California, San Diego, Department of Surgery, San Diego, California.
authors.forename: Bryan
authors.initials: B
authors.lastname: Sandler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015390:Gastric Bypass / Q000379:methods / Q000592:standards*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult
keywords: Gastric bypass outcomes; Longitudinal laparoscopic outcomes; Roux-en-Y gastric bypass