Trends in Use of Bariatric Surgery, 2003−2008

Department of Surgery, University of California Irvine Medical Center, Orange, CA 92868, USA.
Journal of the American College of Surgeons (Impact Factor: 5.12). 08/2011; 213(2):261-266. DOI: 10.1016/j.jamcollsurg.2011.04.030


During the past decade, the field of bariatric surgery has changed dramatically. This study was intended to determine trends in the use of bariatric surgery in the United States. Data used were from the Nationwide Inpatient Sample from 2003 through 2008.
We used ICD-9 diagnosis and procedural codes to identify all hospitalizations during which a bariatric procedure was performed for the treatment of morbid obesity between 2003 and 2008. Data were reviewed for patient characteristics, annual number of bariatric procedures, and proportion of laparoscopic cases. US Census data were used to calculate the population-based annual rate of bariatric surgery per 100,000 adults. The number of surgeons performing bariatric surgery was estimated by the number of members in the American Society for Metabolic and Bariatric Surgery.
For the period between 2003 and 2008, the number of bariatric operations peaked in 2004 at 135,985 cases and plateaued at 124,838 cases in 2008. The annual rate of bariatric operations peaked at 63.9 procedures per 100,000 adults in 2004 and decreased to 54.2 procedures in 2008. The proportion of laparoscopic bariatric operations increased from 20.1% in 2003 to 90.2% in 2008. The number of bariatric surgeons with membership in the American Society for Metabolic and Bariatric Surgery increased from 931 to 1,819 during the 6 years studied. The in-hospital mortality rate decreased from 0.21% in 2003 to 0.10% in 2008.
In the United States, the number of bariatric operations peaked in 2004 and plateaued thereafter. Use of the laparoscopic approach to bariatric surgery has increased to >90% of bariatric operations. In-hospital mortality continually decreased throughout the 6-year period.

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    • "Obesity is a chronic, societal health burden leading to an increased prevalence of insidious co-morbidities, specifically diabetes mellitus and hypertension, 2 of the main risk factors predisposing to both acute and chronic kidney diseases [1]. In response to increasing obesity rates there has been a sustained rise in the incidence of bariatric surgery with improving surgical and anesthetic techniques inevitably leading to more complex patients being offered weight reduction surgery [2] [3] [4] [5]. A multidisciplinary bariatric surgical approach is currently the most effective treatment for the burgeoning problem of obesity with 1550-7289/ r 2015 American Society for Metabolic and Bariatric Surgery. "
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    ABSTRACT: A multidisciplinary bariatric surgical approach is currently the most effective treatment for obesity. However, little is known about how the physiologic impact of weight reduction surgery superimposed on premorbid obesity-related co-morbidities may adversely influence perioperative renal function. This observational, multicenter study investigated all bariatric surgery patients (n = 590) admitted to any intensive care unit (ICU) in Western Australia between 2007 and 2011. Using Acute Kidney Injury Network (AKIN) criteria, we ascertained the incidence and contributing risk factors for acute kidney injury (AKI). Acute kidney injury (AKI) occurred in 103 patients, accounting for 17.5% of all ICU admissions after bariatric surgery with 76.8% of the AKI episodes limited to AKIN stage 1. In a multivariate analysis, male gender, premorbid hypertension, higher admission APACHE II scores, and blood transfusions were all associated with AKI, while preexisting chronic kidney disease and body mass index (BMI) appeared not to influence renal decline. Both ICU (6.7 versus 2.5 d, P<.001) and hospital (18.6 versus 6.8 d, P<.001) length of stays were significantly increased after AKI. Six patients required hemodialysis while both ICU mortality (2.9 versus 0%, P = .005) and long-term mortality (18.2 versus 4.7 deaths per 1000 bariatric patient-yr, P = .01) were greater in patients experiencing AKI. AKI is common in bariatric patients requiring critical care support leading to increased healthcare utilization, prolonged hospitalization, and is associated with a higher mortality. BMI, a previously described risk factor, was not predictive of AKI in this cohort. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Jan 2015 · Surgery for Obesity and Related Diseases
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    • "In particular, it is not clear how bariatric surgery in one family member affects healthy lifestyle behavior modifications among the patient and family members in the patient's social network who have not had surgery. With the prevalence of bariatric surgery prominent [19], evaluating the effects of surgery on family members is of importance. The aim of the present study was to review and describe the state of the literature in terms of family-based approaches to improving metabolic outcomes in bariatric surgery patients and their families. "
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    ABSTRACT: Background Bariatric surgery must be partnered with post-operative lifestyle modifications for enduring weight loss and related health effects to be fully appreciated. Little is known about how these lifestyle modifications may be affected by the involvement of other family members living in the household; therefore, this review describes current family-based approaches to improving post-operative outcomes in bariatric surgery patients and their families. Methods A MEDLINE search of publications between 1999-to-2014 was conducted in January 2014. Retrieved titles and abstracts were assessed by two authors to determine relevance to the topic surrounding family-based approaches to improve post-bariatric surgery outcomes. All study designs except case studies were considered if they included some aspect of family as a predictor in relation to improved health outcomes after surgery. Results Initial searches yielded 650 publications (bariatric surgery + family n=193; bariatric surgery + child n=338; bariatric surgery + spouse n=4; bariatric surgery + social support n=115). Two studies met criteria for a family-based approach to improving metabolic outcomes in bariatric patients. Seven studies discussed the impact of bariatric surgery on families. All other studies were excluded for not discussing family-based approaches. Conclusions Despite limited documentation of family-based approaches on improving health outcomes in patients who underwent bariatric surgery, evidence suggests that such an approach may be advantageous if planned a priori to occur before, during, and after bariatric surgery. Future studies could test the combination of bariatric surgery and a family-based approach for improved metabolic outcomes in both the patient and involved family member(s).
    Full-text · Article · Aug 2014 · Surgery for Obesity and Related Diseases
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    • "Among bariatric surgeries, Roux-en-Y gastric bypass (RYGB), including components of restriction (a small gastric pouch) and malabsorption (bypass of the stomach and proximal portion of small intestine), was endorsed by National Institutes of Health Consensus Development Panel as the ‘gold standard’ procedure in 1991 because of its predictable high weight-loss efficacy and low post-operative complication rates [1]. Subsequently, this procedure has been the most commonly performed bariatric surgery (60–80 %) in the US, with more than 700,000 persons in the US over the last decade having undergone RYGB [2]. In recent years sleeve gastrectomy (SG), a procedure in which there is selective removal of the gastric fundus and greater curvature of the stomach without intestinal bypass, has also become popular, with comparable weight loss to RYGB [3], from a technically easier procedure; SG comprised approximately one-third of bariatric procedures in 2012 [4]. "
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    ABSTRACT: To date, weight loss surgeries are the most effective treatment for obesity and glycemic control in patients with type 2 diabetes. Roux-en-Y gastric bypass surgery (RYGB) and sleeve gastrectomy (SG), two widely used bariatric procedures for the treatment of obesity, induce diabetes remission independent of weight loss while glucose improvement after adjustable gastric banding (AGB) is proportional to the amount of weight loss. The immediate, weight-loss independent glycemic effect of gastric bypass has been attributed to postprandial hyperinsulinemia and an enhanced incretin effect. The rapid passage of nutrients into the intestine likely accounts for significantly enhanced glucagon like-peptide 1 (GLP-1) secretion, and postprandial hyperinsulinemia after GB is typically attributed to the combined effects of elevated glucose and GLP-1. For this review we focus on the beneficial effects of the three most commonly performed bariatric procedures, RYGB, SG, and AGB, on glucose metabolism and diabetes remission. Central to this discussion will be the extent to which the effects of surgery are mediated by GLP-1. Better understanding of these mechanisms could provide insight to development of novel therapeutic strategies for treatment of diabetes as well as refinement of surgical techniques.
    Preview · Article · Jun 2014 · Reviews in Endocrine and Metabolic Disorders
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