title: Comparative effectiveness of primary bariatric operations in the United States.
abstract: BACKGROUND
  Four current bariatric operations were compared after matching patients for differences at baseline. Operations with greater weight loss and resolution of co-morbidities also incurred more adverse events. Reflux was best treated by gastric bypass and type 2 diabetes with duodenal switch. These results can guide decision making regarding choice of bariatric operation. Relative outcomes of common primary bariatric operations have not been compared previously in a large multisite cohort from surgeons in multiple surgical centers.
  
  
  OBJECTIVE
  Compare outcomes of primary bariatric operations in a matched national sample.
  
  
  METHODS
  Bariatric Surgery Centers of Excellence in the United States of America METHODS: Data from Bariatric Surgery Center of Excellence Data File was queried from June 2007 to September 2011 for 30-day and 1-year adverse events, 1-year weight loss and comorbidity resolution. Inverse probability weighting accounted for covariate imbalances in multivariable linear/logistic regressions estimates of differences/odds ratios for each pairwise surgical procedure comparison. A Bonferroni correction was applied to account for multiple pairwise comparisons.
  
  
  RESULTS
  Among 130,796 patients, 57,094 patients underwent AGB, 5942 patients underwent SG, 66,324 patients underwent RYGB and 1436 patients underwent BPD/DS. Compared with AGB, change in body mass index units at 1 year for BPD/DS was 10.6 (standard error [SE]: .15), RYGB 9.3 (SE: .03), and SG 5.7 (SE: .06). Resolution of GERD was best for RYGB (odds ratio [OD] = 1.5, 95% confidence interval [CI]: 1.48-1.58) and lowest for SG (OR = 0.87, 95% CI: .79-.95). Hypertension and T2D resolution were better after the BPD/DS (OR = 3.82, 95% CI: 3.21-4.55, and OR = 5.62, 95% CI: 4.60-6.88, respectively) or after RYGB (OR = 3.08, 95% CI: 2.98-3.18 and OR = 3.5, 95% CI: 3.39-3.64, respectively). Odds of serious adverse events at 1 year were: SG, OR = 3.22, 95% CI: 2.64-3.92; RYGB, OR = 4.92, 95% CI: 4.38-5.54; BPD/DS, OR = 17.47, 95% CI: 14.19-21.52.
  
  
  CONCLUSIONS
  Odds of adverse events and co-morbidity resolution were determined after matching for baseline characteristics. RYGB was associated with highest resolution of GERD, whereas BPD/DS was associated with highest resolution of T2D. These findings can guide decision making regarding choice of bariatric operation.
authors.affiliation: School of Medicine, Department of Surgery, Duke University, Durham, North Carolina. Electronic address: Ranjan.sudan@duke.edu.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sudan
authors.affiliation: School of Medicine, Department of Surgery, Duke University, Durham, North Carolina; Health Services Research and Development, Durham VA Medical Center, Durham, North Carolina.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Amber R
authors.initials: AR
authors.lastname: Wilk
authors.affiliation: Irvine School of Medicine, University of California, Irvine, Department of Surgery, California.
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.affiliation: CHI Memorial Hospital, Chattanooga, Tennessee.
authors.forename: Jaime
authors.initials: J
authors.lastname: Ponce
authors.affiliation: Department of Surgery, Stanford University, Palo Alto, California.
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: D000704:Analysis of Variance; D050110:Bariatric Surgery / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D013531:Surgicenters / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss / Q000502:physiology