Trends and Outcomes of Laparoscopic Sleeve Gastrectomy Between 2015 and 2018 in the USA and Canada
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Trends and Outcomes of Laparoscopic Sleeve Gastrectomy Between 2015 and 2018 in the USA and Canada Jerry T. Dang 1,2 & Jaclyn Shelton 3 & Valentin Mocanu 1 & Warren Sun 1 & Daniel W. Birch 1 & Shahzeer Karmali 1 & Noah J. Switzer 1 Received: 25 April 2020 / Revised: 14 August 2020 / Accepted: 17 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Given there are approximately 100,000 primary laparoscopic sleeve gastrectomy (LSG) procedures performed a year in North America, 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 from 854 centers in the USA and Canada. Patients undergoing primary LSG were included. Statistical analysis was performed to characterize trends in patient factors, technical factors, and 30-day postoperative outcomes. Results A total of 434,030 patients underwent primary LSG. The mean age was 44.2 (SD 12.0) years and mean body mass index was 45.1 (SD 7.8) kg/m2. Baseline demographics did not vary appreciably by year. Operative time decreased from 2015 to 2018 (75.4 to 70.6 min, p < 0.001). Bougie size and stapling distance from the pylorus did not change by year. However, staple line reinforcement (66.8 to 63.2%, p < 0.001) and oversewing of the staple line (23.1 to 20.1%, p < 0.001) were less commonly performed. Postoperatively, from 2015 to 2018, there was a 45.8% relative reduction in leaks (0.48 to 0.26%, p < 0.001). There were also reductions in 30-day major complications (2.87 to 2.28%, p < 0.001), length of stay (1.72 to 1.44 days, p < 0.001), and readmissions (3.39 to 2.77%, p < 0.001). Conclusions From 2015 to 2018, there was a decrease in staple line reinforcement and oversewing. These changes correlated with reductions in operative time, length of stay, readmission, and major complications. Keywords Sleeve gastrectomy . Bariatric surgery . Surgical outcomes . Staple line reinforcement . Oversew . Pylorus distance . Bougie size
Introduction The prevalence of obesity has increased markedly in North America over recent years, with current US data citing adult
obesity rates of over 40% in 2017 and 2018 [1, 2]. The growing obesity epidemic has consequently led to an increased prevalence of obesity-related metabolic comorbidities [3]. Together, these comorbidities significantly influence patient
* Jerry T. Dang [email protected]
Shahzeer Karmali [email protected] Noah J. Switzer [email protected]
Jaclyn Shelton [email protected] Valentin Mocanu [email protected]
1
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
2
Division of General Surgery, Department of Surgery, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB T6G 2B7, Canada
3
Faculty of Medicine and Dentistry, University of Albert
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