TRENDS OF SLEEVE GASTRECTOMY AND POST-OPERATIVE WEIGHT LOSS PHARMACOTHERAPY OVER 10 YEARS: A LARGE DATABASE STUDY
Raj Shah2, Abbinaya Elangovan*1, Zachary L. Smith2
1MetroHealth Medical Center/ Case Western Reserve University, Cleveland, OH; 2University Hospital Cleveland Medical Center/ Case Western Reserve University, Cleveland, OH
Background
Treating obesity and weight recidivism continues to be a major challenge in the United States (US). Among the various bariatric surgery procedures currently available, sleeve gastrectomy (SG) is the most commonly performed procedure in the US. Adjuvant pharmacological treatment (APT) has been shown to mitigate weight gain following bariatric surgery. While obesity has increased exponentially in the past decade, the trends of bariatric procedures and post-operative pharmacotherapy in this timeline is not well established. We aimed to determine the prevalence of SG, and post-operative APT using a large national database.
Methods
We retrospectively reviewed individuals with BMI ≥ 30 who underwent SG using a population level commercial database, IBM Explorys. Explorys aggregates de-identified electronic health record data across 26 health care networks in the US. The de-identified nature of the data limits our ability to identify the precise indication of procedures hence RYGB which has several non-bariatric indications was not included as part of the study. We studied the individuals who were prescribed at least one weight loss medication [orlistat, liraglutide (Saxenda), lorcaserin, phentermine-topiramate, bupropion-naltrexone, phentermine, diethylpropion, benzphetamine, and phendimetrazine] at least 7 days after the procedure. The data was analyzed using univariate odds ratio and significance of the difference between two independent proportions.
Results
Among the 9,848,700 obese adults reviewed in the study period, 24,350 (0.25%) obese adults had undergone SG. There was a significant increase in SG from 2009 to 2018 (0.003% vs 0.143%, p < 0.0001). Anti-obesity pharmacotherapy was prescribed to 1630 (6.7%) patients following SG, the trend has ranged from 2.4% to 4.2% in the last 5 years. 56% of medications were prescribed within a year of surgery (Figure 1). Among the medications, phentermine (65%) was the most commonly prescribed drug followed by bupropion/naltrexone (16.5%) and phentermine/topiramate (16.5%). Women (odds ratio OR 1.61, confidence interval CI 1.39 to 1.86) and African Americans (OR 1.6, CI 1.41 – 1.79) were more likely to be prescribed weight loss medications following bariatric surgery (Table 1).
Discussion
The proportion of obese adults who are undergoing SG has expanded significantly. Despite the growing trend, sleeve gastrectomy and post-operative anti-obesity pharmacotherapy are underutilized in the US with < 1% of obese adults undergoing SG out of which < 5% being prescribed anti-obesity pharmacotherapy. Further large-scale studies are required to explore interventions to increase the utilization of these therapies.
Figure 1: Anti-obesity pharmacotherapy following sleeve gastrectomy
Table 1: Demographics of the study population
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