Mengyi Li1, Na Zeng2, Yang Liu1, Wenmao Yan3, Songhai Zhang4, Liangping Wu5, Shaozhuang Liu6, Jun Wang7, Xiangwen Zhao8, Jianli Han9, Jiansheng Kang10, Nengwei Zhang11, Peng Zhang12, Rixing Bai13, Zhongtao Zhang14. 1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, No.95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. 2. National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China. 3. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South West Ring Road, Fengtai District, Beijing, 100070, China. 4. Department of Metabolic and Bariatric Surgery, Xinxiang Second People's Hospital, No.389 Middle Section of Hongli Avenue, Muye District, Xinxiang, 453002, Henan Province, China. 5. Jinshazhou Hospital of Guangzhou University of Chinese Medicine, No.1 Li-Chuan East Street, Baiyun District, Guangzhou, 510168, Guangdong Province, China. 6. Department of Metabolic and Bariatric Surgery, Department of General Surgery, Qilu Hospital of Shandong University, No.107 Cultural West Road, Jinan, 250012, Shandong Province, China. 7. Department of Gastrointestinal Surgery, Tangshan Gongren Hospital, No.27 Cultural Road, Lubei District, Tangshan, 063000, Hebei Province, China. 8. Department of Metabolic and Bariatric Surgery, Xiaolan People's Hospital of Zhongshan, No.65 Middle Section of Jucheng Avenue, Zhongshan, 528415, Guangdong Province, China. 9. Department of General Surgery, Bethune Hospital of Shanxi, No.99 Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi Province, China. 10. Department of General Surgery, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang, 050000, Hebei Province, China. 11. Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University/Peking University, Ninth Clinical Medical College, Tieyilu 10, Yangfangdian, Haidian District, Beijing, 100038, China. 12. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, No.95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. zhangpg@yahoo.com. 13. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South West Ring Road, Fengtai District, Beijing, 100070, China. brx5168@163.com. 14. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, No.95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China. zhangzht@ccmu.edu.cn.
Abstract
PURPOSE: To determine whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) should be the optimal choice in patients stratified by diabetes duration and body mass index (BMI) level. METHODS: Classification tree analysis was performed to identify the influential factors for surgical procedure selection in real setting. Meta-analyses stratified by influential factors were conducted to compare the complete diabetes remission rates between SG and RYGB. The cost-effectiveness analysis was performed when results from meta-analysis remain uncertain. RESULTS: Among 3198 bariatric procedures in China, 824 (73%) SGs and 191 (17%) RYGBs were performed in patients with T2DM. Diabetes duration with a cutoff value of 5 years and BMI level with 35.5 kg/m2 were identified as the influential factors. For patients with diabetes duration > 5 years, RYGB showed a significant higher complete diabetes remission rate than SG at 1 year: 0.52 (95% confidence interval (CI): 0.46-0.58) versus 0.36 (95% CI: 0.30-0.42). For patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m2, there was no significant difference between 2 procedures: 0.57 (95% CI: 0.43-0.71) for SG versus 0.66 (95% CI: 0.62-0.70) for RYGB. The cost-effectiveness ratios of SG and RYGB were 244.58 and 276.97 dollars per QALY, respectively. CONCLUSIONS: For patients with diabetes duration > 5 years, RYGB was the optimal choice with regard to achieving complete diabetes remission at 1 year after surgery. However, for patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m2, SG appeared to provide a cost-effective choice.
PURPOSE: To determine whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) should be the optimal choice in patients stratified by diabetes duration and body mass index (BMI) level. METHODS: Classification tree analysis was performed to identify the influential factors for surgical procedure selection in real setting. Meta-analyses stratified by influential factors were conducted to compare the complete diabetes remission rates between SG and RYGB. The cost-effectiveness analysis was performed when results from meta-analysis remain uncertain. RESULTS: Among 3198 bariatric procedures in China, 824 (73%) SGs and 191 (17%) RYGBs were performed in patients with T2DM. Diabetes duration with a cutoff value of 5 years and BMI level with 35.5 kg/m2 were identified as the influential factors. For patients with diabetes duration > 5 years, RYGB showed a significant higher complete diabetes remission rate than SG at 1 year: 0.52 (95% confidence interval (CI): 0.46-0.58) versus 0.36 (95% CI: 0.30-0.42). For patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m2, there was no significant difference between 2 procedures: 0.57 (95% CI: 0.43-0.71) for SG versus 0.66 (95% CI: 0.62-0.70) for RYGB. The cost-effectiveness ratios of SG and RYGB were 244.58 and 276.97 dollars per QALY, respectively. CONCLUSIONS: For patients with diabetes duration > 5 years, RYGB was the optimal choice with regard to achieving complete diabetes remission at 1 year after surgery. However, for patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m2, SG appeared to provide a cost-effective choice.
Authors: J L Hedenbro; E Näslund; L Boman; G Lundegårdh; A Bylund; M Ekelund; A Laurenius; P Möller; T Olbers; M Sundbom; J Ottosson; I Näslund Journal: Obes Surg Date: 2015-10 Impact factor: 4.129
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