I. Nassour1,3, S. Kukreja1,3, J. P. Almandoz2, N. Puzziferri1,3 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2University Of Texas Southwestern Medical Center,Endocrinology,Dallas, TX, USA 3VA North Texas Health Care System,Surgery,Dallas, TX, USA
Introduction: Veterans Affairs (VA) Health Care System patients undergoing bariatric surgery differ from other groups as having greater: numbers of men, age, and prevalence of metabolic comorbidities. While bariatric surgery significantly improves weight and cardiometabolic risk factors, there is limited long-term evidence of outcomes in men or cohorts with complete follow-up. We evaluated 4-year outcomes of VA patients following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in regards to weight, type 2 diabetes mellitus (T2DM), hypertension (HTN), hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL), and complications.
Methods: Consecutive patients who underwent RYGB or SG at the Dallas VA from 2003 to 2011 were retrospectively reviewed. Collected data included demographics, weight, body mass index (BMI), comorbidity diagnoses, medications, and complications. Outcome means for weight and BMI were compared by t-test. Partial remission for T2DM was defined as: hemoglobin A1c <6.5%, without medications. Remission was defined as: blood pressure <140/90 mmHg without medications for HTN; triglycerides <150 mg/dl without medications for hypertriglyceridemia; and HDL >40 mg/dl without medications for low HDL.
Results:256 patients (59% male; mean age 53) underwent RYGB (n=159; 140/159 open technique) and SG (n=97). Ninety-five percent of patients were followed to 4 years after surgery. Mean preoperative weight and BMI were 132 kg (SD=25) and 44 kg/m2 (SD=7) respectively. Baseline comorbity prevalence was 52%T2DM, 83% HTN, 67% hypertriglyceridemia, and 64% low HDL. At 4 years, the mean weight was 104 kg (SD=26; p <0.001) and mean BMI 35 kg/m2 (SD=7; p <0.001). Patients lost more weight after RYGB than SG (68 kg, 95% Cl (60.7, 74.0) vs. 28 kg, 95% CI (21.9, 35.0); p=0.01). T2DM partial remission rates were 35% after RYGB, and 19% after SG. HTN remission rates were 23% after RYGB, and 21% after SG. Hypertriglyceridemia and low HDL remission rates were 34% each after RYGB; 20% and 12%, respectively, after SG. Complications (>30 days post surgery) occurred in 27% of SG patients (n=26) and in 61% of RYGB patients (n=97). Most late complications were micronutrient deficiencies: 42% after RYGB, 26% after SG. Complications requiring reoperation included: hernia, cholecystitis, and obstruction (n=31,RYGB, 31/37 open technique; n=4, SG). Ten deaths occurred 1-4 years after RYGB (n=7) and SG (n=3).
Conclusion:VA patients who underwent RYGB or SG demonstrated significant and durable weight loss with improvement in obesity-related comorbidities at 4-year follow-up. RYGB yielded greater weight loss, and remission rates for T2DM, hypertriglyceridemia, and low HDL. HTN remission rates were similar for both operations. Late required reoperations after gastric bypass were associated with the open vs. laparoscopic approach. Micronutrient deficiencies are prevalent after both operations.