FOUR YEARS OF LAPAROSCOPIC SLEEVE GASTRECTOMY IN NORTH AMERICA: TRENDS IN SURGICAL TECHNIQUES AND PATIENT OUTCOMES
Jerry Dang*, Valentin Mocanu, Warren Sun, Daniel W. Birch, Shahzeer Karmali, Noah Switzer
Department of Surgery, University of Alberta, Edmonton, AB, Canada
Background
In the past decade, laparoscopic sleeve gastrectomy (LSG) became the most commonly performed bariatric surgery in North America. Given there are approximately 100,000 procedures performed a year in this region, there is a need to evaluate recent trends in LSG. The objective of this study was to analyze the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to identify trends in technical factors and patient outcomes over time.
Methods
The MBSAQIP prospectively collects data based on standardized definitions for pre-, intra-, and post-operative variables that are specific for metabolic and bariatric surgery. This data is collected from 854 centers in the United States and Canada and captures approximately 95% of all procedures. Data were included from all available years of the MBSAQIP database (2015 to 2018).
Patients undergoing primary LSG were included. Patients with previous bariatric surgery or undergoing an emergency procedure were excluded. Statistical analysis was performed to characterize trends in patient factors, technical factors and 30-day outcomes.
Results
A total of 389,839 patients underwent primary LSG. The mean age was 44.2 (SD 12.0) years, 79.4% were female and mean body mass index was 45.1 (SD 7.8) kg/m2 (Table 1). Baseline demographics and patient comorbidities did not vary appreciably by year. From 2015 to 2018, LSG had increasing prevalence over Roux-en-Y gastric bypass (70.0%, 73.3%, 74.7% 75.1%, p<0.001).
Operative time gradually decreased from 2015 to 2018 (75.7 to 70.6 minutes, p<0.001). Regarding technical factors, bougie size (37.0 Fr, SD 2.9) and stapling distance from the pylorus (4.83 cm, SD 1.10) did not change appreciably by year. However, from 2015 to 2018, fewer surgeons performed staple line reinforcement (66.9 to 63.8%, p<0.001) and oversewing of the staple line (22.7 to 20.1%, p<0.001).
Postoperatively, there was a 45% reduction in leaks (0.47 to 0.26%, p<0.001) with stable rates of postoperative bleeding (0.69 to 0.70%, p=0.003). This contributed to a reduction in 30-day major complications (2.84 to 2.27%, p<0.001), length of hospital stays (1.71 to 1.44 days, p<0.001) and rates of readmission (3.35 to 2.76%, p<0.001). However, the rate of 30-day mortality remained unchanged (0.08%, p=0.046).
Conclusions
Rates of LSG procedures in North American MBSAQIP accredited centers continue to increase, now encompassing over 75% of major bariatric procedures. From 2015 to 2018, changes in technical factors included a decrease in staple line reinforcement and oversewing of the staple line. These changes were associated with a reduction in operative time, postoperative leaks, and major complications suggesting improved technical proficiency as well as reductions in hospital utilization with reduced length of hospital stays and readmissions.
Table 1. Patient demographics, technical factors and 30-day outcomes by operative year
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