Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry

Sandhya B. Kumar, Barbara C. Hamilton, Stephanie Wood, Stanley J. Rogers, Jonathan T. Carter, Matthew Y. Lin

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has become popular due to its technical ease and excellent short-term results. Understanding the risk profile of LSG compared with the gold standard laparoscopic Roux-en-Y gastric bypass (LRYGB) is critical for patient selection. Objectives: To use traditional regression techniques and random forest classification algorithms to compare LSG with LRYGB using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Data Registry. Setting: United States. Methods: Outcomes were leak, morbidity, and mortality within 30 days. Variable importance was assessed using random forest algorithms. Multivariate models were created in a training set and evaluated on the testing set with receiver operating characteristic curves. The adjusted odds of each outcome were compared. Results: Of 134,142 patients, 93,062 (69%) underwent LSG and 41,080 (31%) underwent LRYGB. One hundred seventy-eight deaths occurred in 96 (.1%) of LSG patients compared with 82 (.2%) of LRYGB patients (P<.001). Morbidity occurred in 8% (5.8% in LSG versus 11.7% in LRYGB, P<.001). Leaks occurred in 1% (.8% in LSG versus 1.6% in LRYGB, P<.001). The most important predictors of all outcomes were body mass index, albumin, and age. In the adjusted multivariate models, LRYGB had higher odds of all complications (leak: odds ratio 2.10, P<.001; morbidity: odds ratio 2.02, P<.001; death: odds ratio 1.64, P<.01). Conclusion: In the Metabolic and Bariatric Surgery Accreditation and Quality Improvements data registry for 2015, LSG had half the risk-adjusted odds of death, serious morbidity, and leak in the first 30 days compared with LRYGB.

Original languageEnglish (US)
Pages (from-to)264-269
Number of pages6
JournalSurgery for Obesity and Related Diseases
Volume14
Issue number3
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

Fingerprint

Gastric Bypass
Gastrectomy
Registries
Bariatric Surgery
Morbidity
Accreditation
Odds Ratio
Quality Improvement
ROC Curve
Patient Selection
Albumins
Body Mass Index
Mortality

Keywords

  • Laparoscopic Roux-en-Y gastric bypass
  • Laparoscopic sleeve gastrectomy
  • MBSAQIP
  • Perioperative complications

ASJC Scopus subject areas

  • Surgery

Cite this

Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry. / Kumar, Sandhya B.; Hamilton, Barbara C.; Wood, Stephanie; Rogers, Stanley J.; Carter, Jonathan T.; Lin, Matthew Y.

In: Surgery for Obesity and Related Diseases, Vol. 14, No. 3, 01.03.2018, p. 264-269.

Research output: Contribution to journalArticle

Kumar, Sandhya B. ; Hamilton, Barbara C. ; Wood, Stephanie ; Rogers, Stanley J. ; Carter, Jonathan T. ; Lin, Matthew Y. / Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry. In: Surgery for Obesity and Related Diseases. 2018 ; Vol. 14, No. 3. pp. 264-269.
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abstract = "Background: Laparoscopic sleeve gastrectomy (LSG) has become popular due to its technical ease and excellent short-term results. Understanding the risk profile of LSG compared with the gold standard laparoscopic Roux-en-Y gastric bypass (LRYGB) is critical for patient selection. Objectives: To use traditional regression techniques and random forest classification algorithms to compare LSG with LRYGB using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Data Registry. Setting: United States. Methods: Outcomes were leak, morbidity, and mortality within 30 days. Variable importance was assessed using random forest algorithms. Multivariate models were created in a training set and evaluated on the testing set with receiver operating characteristic curves. The adjusted odds of each outcome were compared. Results: Of 134,142 patients, 93,062 (69{\%}) underwent LSG and 41,080 (31{\%}) underwent LRYGB. One hundred seventy-eight deaths occurred in 96 (.1{\%}) of LSG patients compared with 82 (.2{\%}) of LRYGB patients (P<.001). Morbidity occurred in 8{\%} (5.8{\%} in LSG versus 11.7{\%} in LRYGB, P<.001). Leaks occurred in 1{\%} (.8{\%} in LSG versus 1.6{\%} in LRYGB, P<.001). The most important predictors of all outcomes were body mass index, albumin, and age. In the adjusted multivariate models, LRYGB had higher odds of all complications (leak: odds ratio 2.10, P<.001; morbidity: odds ratio 2.02, P<.001; death: odds ratio 1.64, P<.01). Conclusion: In the Metabolic and Bariatric Surgery Accreditation and Quality Improvements data registry for 2015, LSG had half the risk-adjusted odds of death, serious morbidity, and leak in the first 30 days compared with LRYGB.",
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AU - Carter, Jonathan T.

AU - Lin, Matthew Y.

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AB - Background: Laparoscopic sleeve gastrectomy (LSG) has become popular due to its technical ease and excellent short-term results. Understanding the risk profile of LSG compared with the gold standard laparoscopic Roux-en-Y gastric bypass (LRYGB) is critical for patient selection. Objectives: To use traditional regression techniques and random forest classification algorithms to compare LSG with LRYGB using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Data Registry. Setting: United States. Methods: Outcomes were leak, morbidity, and mortality within 30 days. Variable importance was assessed using random forest algorithms. Multivariate models were created in a training set and evaluated on the testing set with receiver operating characteristic curves. The adjusted odds of each outcome were compared. Results: Of 134,142 patients, 93,062 (69%) underwent LSG and 41,080 (31%) underwent LRYGB. One hundred seventy-eight deaths occurred in 96 (.1%) of LSG patients compared with 82 (.2%) of LRYGB patients (P<.001). Morbidity occurred in 8% (5.8% in LSG versus 11.7% in LRYGB, P<.001). Leaks occurred in 1% (.8% in LSG versus 1.6% in LRYGB, P<.001). The most important predictors of all outcomes were body mass index, albumin, and age. In the adjusted multivariate models, LRYGB had higher odds of all complications (leak: odds ratio 2.10, P<.001; morbidity: odds ratio 2.02, P<.001; death: odds ratio 1.64, P<.01). Conclusion: In the Metabolic and Bariatric Surgery Accreditation and Quality Improvements data registry for 2015, LSG had half the risk-adjusted odds of death, serious morbidity, and leak in the first 30 days compared with LRYGB.

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