Long-term comparative effectiveness of gastric bypass and sleeve gastrectomy on use of antireflux medication: a difference-in-differences analysis

Ryan Howard; Jie Yang; Jyothi Thumma; David E Arterburn; Andrew Ryan; Grace Chao; Dana Telem; Justin B Dimick

doi:10.1016/j.soard.2022.04.016

Long-term comparative effectiveness of gastric bypass and sleeve gastrectomy on use of antireflux medication: a difference-in-differences analysis

Surg Obes Relat Dis. 2022 Aug;18(8):1033-1041. doi: 10.1016/j.soard.2022.04.016. Epub 2022 Apr 22.

Authors

Ryan Howard¹, Jie Yang², Jyothi Thumma², David E Arterburn³, Andrew Ryan⁴, Grace Chao⁵, Dana Telem⁶, Justin B Dimick⁷

Affiliations

¹ Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
² Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
³ Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
⁴ Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Center for Evaluating Health Reform, University of Michigan, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan.
⁵ Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
⁶ Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
⁷ Department of Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: jdimick@med.umich.edu.

PMID: 35649735
DOI: 10.1016/j.soard.2022.04.016

Abstract

Background: Gastroesophageal reflux (GERD) is common among patients with obesity who undergo bariatric surgery. Although gastric bypass and sleeve gastrectomy are the most common bariatric operations performed in the United States, their long-term comparative effectiveness on GERD medication use is unknown.

Objective: To compare the long-term effectiveness of gastric bypass and sleeve gastrectomy on use of antireflux medication.

Setting: National cohort undergoing inpatient bariatric surgery.

Methods: This is a retrospective study of Medicare beneficiaries undergoing gastric bypass and sleeve gastrectomy between January 1, 2012, and December 31, 2017. A difference-in-differences analysis was conducted to evaluate the differential change in antireflux medication use between groups before and after surgery.

Results: A total of 16,640 patients underwent gastric bypass, and 26,724 patients underwent sleeve gastrectomy. Before surgery, GERD medication use was higher among patients who underwent gastric bypass (62.4%; 95% confidence interval [CI]: 62.0%-63.7%) compared with patients who underwent sleeve gastrectomy (60.1%; 95% CI: 59.3%-60.9%). Five years after surgery, GERD medication use was lower in patients who underwent gastric bypass (47.8%; 95% CI: 46.3%-49.3%) compared with patients who underwent sleeve gastrectomy (53.7%; 95% CI: 50.5%-56.9%). The differential decrease from baseline GERD medication use was greater for patients who underwent gastric bypass at 2 years (-4.1 percentage points [pp]; 95% CI: -1.7 to -6.5 pp), 3 years (-4.3 pp; 95% CI: -1.6 to -7.0 pp), 4 years (-6.9 pp; 95% CI: -4.1 to -9.6 pp), and 5 years (-8.3 pp; 95% CI: -3.7 to 12.8 pp) after surgery.

Conclusion: Though use of antireflux medication decreased following both procedures, gastric bypass was associated with a greater reduction in antireflux medication use 5 years after surgery compared with sleeve gastrectomy. Understanding the long-term comparative effectiveness of these common bariatric operations may better inform treatment decisions among patients and surgeons.

Keywords: Bariatric surgery; Comparative effectiveness research; Difference-in-differences; Gastroesophageal reflux disease; Outcomes; Surgery.

MeSH terms

Aged
Gastrectomy / methods
Gastric Bypass* / methods
Gastroesophageal Reflux* / complications
Gastroesophageal Reflux* / drug therapy
Gastroesophageal Reflux* / surgery
Humans
Laparoscopy*
Medicare
Obesity, Morbid* / complications
Retrospective Studies
Treatment Outcome
United States