Background

In the last 10 years, there has been a dramatic shift in the types of bariatric procedures performed in the U.S., however long-term data comparing the weight loss efficacy of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB) are lacking in large, broadly-representative samples.

Methods

For this analysis, we identified adults (age 20-79 years) who underwent a primary bariatric procedure at 41 sites participating in 11 National Patient-Centered Clinical Research Network (PCORnet) sites from January 1, 2005 through September 30, 2015. Comparative estimates of percent change in weight at 1, 3 and 5 years for patients undergoing SG, RYGB, and LAGB were obtained using mixed effects regression with propensity score and covariate adjustment.

Results

A total of 46,510 adults met inclusion criteria for the final cohort, including 18961 SG, 24982 RYGB, and 2567 AGB. This cohort was predominantly female (80%), Caucasian (74%), with mean age 45.5 years and BMI of 49.1 kg/m2. The number with sufficient follow-up data for inclusion in 1-, 3-, and 5-year analyses were 44978, 20783, and 7159, representing 84%, 68%, and 69% of eligible patients. The 1-year mean (95% CI) changes in weight were -25.1% (-24.9%, -25.3%) for SG, -30.7% (-30.6%, -30.9%) for RYGB, and -13.7% (-13.3%, -14.2%) for AGB. At 5 years, the mean changes in weight were -18.0% (-17.1%, -18.8%) for SG, -24.8% (24.4%, 25.3%) for RYGB, and -11.2% (-9.8%, -12.7%) for AGB. Patients with diabetes, BMI <50, age ≥65, male patients, and African American patients lost less weight than those without diabetes, BMI ≥50, age <65, female patients, and Caucasian patients.

Conclusions

The large, multicenter PCORnet Bariatric Study used electronic health records to determine that adults undergoing RYGB experienced the greatest decrease in body weight at 1-, 3-, and 5-years after surgery, as compared to SG and AGB, and there were clinically important subgroup outcome differences.