Trends in Bariatric Surgery: Procedure Selection, Revisional Surgeries, and Readmissions.

BACKGROUND: There are limited data quantifying national trends, post-operative readmissions, and revisional surgeries for bariatric procedures. We hypothesized that there is a trend away from Roux en Y gastric bypass (RYGB) and laparoscopic adjustable gastric bands (LAGB) in favor of vertical sleeve gastrectomies (VSG). We hypothesized that VSG was associated with fewer revisions and readmissions, and that demographics and comorbidities were associated with surgery received.
METHODS: We used the US-based Premier database, 2008-2013 and 2014 first and second quarters to 1. Examine trends in incidence of RYGB, LAGB and VSG. 2. Quantify occurrence of revisional surgeries and readmissions. 3. Identify predictors of receipt of procedure and of readmissions.
RESULTS: The proportion of VSG increased from 3.0 to 54 % from 2008 to 2014. RYGB decreased from 52 % in 2008 to 32 % by 2014. Earlier year, female sex, white race, western (versus southern) region, and Medicaid predicted receipt of RYGB. Later year, male sex, nonwhite race, northeast or western (versus southern) regions, and insurance type predicted VSG. Readmission was less likely for VSG (OR 0.72, 95 % CI 0.65-0.81), male sex (OR 0.83, 95 % CI 0.72-0.95), and more likely for black race (OR Black vs White 1.2, 95 % CI 1.1-1.4).
CONCLUSIONS: Discharge year strongly predicted surgery type. Females, whites, and Medicaid recipients received RYGB more than referents. Conversely, males, non-whites, and insured patients were more likely to receive VSG. Underinsured, regardless of surgery type, were more likely to be readmitted. These findings have important implications for health policy and cost-containment strategies.