Kristina H Lewis1, Katherine Callaway2, Stephanie Argetsinger2, Jamie Wallace2, David E Arterburn3, Fang Zhang2, Adolfo Fernandez4, Dennis Ross-Degnan2, Justin B Dimick5, J Frank Wharam2. 1. Department of Epidemiology & Prevention, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina; Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina. Electronic address: khlewis@wakehealth.edu. 2. Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts. 3. Kaiser Permanente Washington Health Research Institute, Seattle, Washington. 4. Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina. 5. Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications. OBJECTIVES: To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes. SETTING: A 2010-2017 U.S. commercial insurance claims data set. METHODS: We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling. RESULTS: We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years. CONCLUSIONS: Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.
BACKGROUND: Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications. OBJECTIVES: To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes. SETTING: A 2010-2017 U.S. commercial insurance claims data set. METHODS: We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling. RESULTS: We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years. CONCLUSIONS: Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.
Authors: Nancy Krieger; Jarvis T Chen; Pamela D Waterman; David H Rehkopf; S V Subramanian Journal: Am J Public Health Date: 2003-10 Impact factor: 9.308
Authors: Anita Courcoulas; R Yates Coley; Jeanne M Clark; Corrigan L McBride; Elizabeth Cirelli; Kathleen McTigue; David Arterburn; Karen J Coleman; Robert Wellman; Jane Anau; Sengwee Toh; Cheri D Janning; Andrea J Cook; Neely Williams; Jessica L Sturtevant; Casie Horgan; Ali Tavakkoli Journal: JAMA Surg Date: 2020-03-01 Impact factor: 14.766
Authors: Kristina H Lewis; David E Arterburn; Katherine Callaway; Fang Zhang; Stephanie Argetsinger; Jamie Wallace; Adolfo Fernandez; Dennis Ross-Degnan; James F Wharam Journal: JAMA Netw Open Date: 2019-12-02
Authors: Kristina H Lewis; Stephanie Argetsinger; David E Arterburn; Jenna Clemenzi; Fang Zhang; Ronald Kamusiime; Adolfo Fernandez; Dennis Ross-Degnan; James F Wharam Journal: JAMA Netw Open Date: 2022-05-02