Anita P. Courcoulas MD, MPH, FACS Anthony M. Harrison MD Chair and Professor of Surgery Chief, MIS Bariatric & General Surgery University of Pittsburgh Medical Center

Procedures and Hospitalizations Common After Bariatric Procedures Interview with:

Anita P. Courcoulas MD, MPH, FACS Anthony M. Harrison MD Chair and Professor of Surgery Chief, MIS Bariatric & General Surgery University of Pittsburgh Medical Center

Dr. Courcoulas

Anita P. Courcoulas MD, MPH, FACS
Anthony M. Harrison MD Chair and
Professor of Surgery
Chief, MIS Bariatric & General Surgery
University of Pittsburgh Medical Center What is the background for this study?

Response: Fewer published studies in bariatric surgery address long term adverse outcomes or problems that can occur after different operations.  In addition, a lack of standardized reporting of potential adverse events limits the understanding of these issues.

This paper results from one of the largest studies of bariatric surgery ever undertaken and includes both gastric bypass and gastric sleeve, the 2 most common operations performed in the U.S. and worldwide at the current time.  This study leverages large data sets from the electronic health record linked to insurance claims and death indices.  This is real-world data coming from a population-based cohort of 33,560 adults at 10 sites in 4 clinical data research networks throughout the U.S., so it may be different from data that accrues from a longitudinal observational study or randomized trial.  Patients and other important stakeholders in bariatric surgery were critical to the design, conduct, and dissemination of results from this study. What are the main findings?

Response: The main finding of this study is that at five years follow up, interventions and operations, hospitalizations, and endoscopy procedures were relatively common after bariatric surgical procedures and were more often associated with gastric bypass than with gastric sleeve. What should readers take away from your report?

Response: This study highlights important information about what may occur following different bariatric surgical procedures in the longer term. Both patients and physicians need to understand information on both sides of the risk versus benefit equation when considering the decision to undergo bariatric surgery.  These data along with earlier data about differential weight loss outcomes by surgical procedure help to inform high-quality shared decision making conversations around current bariatric procedure options. What recommendations do you have for future research as a result of this work?

Response: It will be important to follow these types of events for an even longer period of time to see if trends remain the same or new events emerge that may be specific to one procedure or another.  It would also be helpful to study the specific reasons for operations, hospitalizations, and endoscopy to understand on an even more granular level why these events occur. For example, we do know that sometimes hospitalization is for a complication of bariatric surgery, but other times it may be for the care of a chronic condition (e.g. joint replacement) that is facilitated by the loss of weight with bariatric surgery.

Finally, data from this study will be used to facilitate the development of a shared decision making educational tool for use by patients and providers to help guide more routine and even more high quality shared decision making conversations around bariatric surgery. Is there anything else you would like to add?

Response: The current study was gathered from data in the real world, and appears to lend support to the finding that operations and interventions occur less commonly after gastric sleeve than after gastric bypass at 5 years follow up.  Furthermore, these data help to set expectations about possible future issues that may occur to balance against the positive impact of reduced weight and improved health conditions.

Any disclosures? No commercial disclosures.

I have grants from NIH, PCORI, and Allurion Inc.


Courcoulas A, Coley RY, Clark JM, et al. Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study. JAMA Surg. Published online January 15, 2020. doi:10.1001/jamasurg.2019.5470



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