Comparing Outcomes of Open Versus Laparscopic Bariatric Surgery

Objective: The objective of this study was to use nationally representative data to compare outcomes of open gastric bypass (OGB) versus laparoscopic gastric bypass (LGB) surgery.
Background: The number of bariatric procedures continues to grow. Increasingly, these surgeries are being performed laparoscopically. However, few population-based studies have examined differences in outcomes between LGB and OGB surgeries. Population-based studies can provide further insight into differences in outcomes between open and laparoscopic bariatric procedures.
Methods: Using the Nationwide Inpatient Sample, we identified adults undergoing LGB or OGB surgery during 2005 (n = 19,156). Following preliminary descriptive statistics, multiple logistic and linear regressions were used to obtain risk-adjusted outcomes, including postoperative in-hospital complications, reoperation, length of stay, and total charges.
Results: The majority of patients in the study sample (74.5%) underwent laparoscopic bypass surgery in 2005. After adjusting for patient and hospital level factors, patients undergoing OGB surgery were more likely to experience reoperation as well as the following complications: pulmonary (odds ratio [OR] = 1.92 (1.54-2.38), P < 0.001); cardiovascular (OR = 1.54 [1.07-2.23], P = 0.02); procedural (OR = 1.29 [1.06-1.57], P < 0.01); sepsis (OR = 2.18 [1.50-3.16], P < 0.001); and anastomotic leak (OR = 1.32 [1.02-1.71], P = 0.03). After risk adjustment, LGB was associated with a shorter length of stay but higher total charges.
Conclusion: Overall, LGB patients are less likely to experience reoperation and postoperative complications in the hospital and have a shorter length of stay but incur higher total charges than OGB patients.

Introduction
Obesity is a major public health concern in the United States. Approximately 31% of Americans are considered obese, including 5% who are morbidly obese (body mass index (BMI) ¡Ý 40 kg/m2).[1,2] Obesity is costly, accounting for more than one quarter of the increase in healthcare spending between 1987 and 2001.[3]

Bariatric surgery has been identified as an effective treatment for persons with a BMI ¡Ý 40 kg/m2 or persons with a BMI ¡Ý 35 kg/m2 and who have a significant comorbidity, such as diabetes, hypertension, or sleep apnea.[4] The number of bariatric surgeries has grown markedly in recent years, increasing more than 400% between 1998 and 2002.[5] As the number of bariatric procedures has increased, more of these procedures are being performed laparoscopically. Laparoscopic approaches to bariatric surgery have been shown to be associated with shorter recovery time, smaller wounds, and less postoperative pain, compared with open procedures.[6] However, most of the evidence of improved outcomes for laparoscopic approaches is drawn from case studies based on small sample sizes and performed by experienced surgeons at single institutions.

Although population-based studies can provide further insight into outcomes and quality of care for patients undergoing open versus laparoscopic bariatric surgical procedures, few studies have actually addressed this topic. Efforts to compare these 2 approaches at the population level using administrative data have been hampered by lack of specific The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for laparoscopic bariatric surgery. In 2004, specific codes for laparoscopy were introduced. The purpose of this study was to use nationally representative data to compare outcomes of open gastric bypass (OGB) versus laparoscopic gastric bypass (LGB) surgery.