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- Title
Medication Use for Obesity-Related Comorbidities After Sleeve Gastrectomy or Gastric Bypass.
- Authors
Howard, Ryan; Chao, Grace F.; Yang, Jie; Thumma, Jyothi R.; Arterburn, David E.; Telem, Dana A.; Dimick, Justin B.
- Abstract
<bold>Importance: </bold>Sleeve gastrectomy and gastric bypass are the most common bariatric surgical procedures in the world; however, their long-term medication discontinuation and comorbidity resolution remain unclear.<bold>Objective: </bold>To compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications up to 5 years after sleeve gastrectomy or gastric bypass.<bold>Design, Setting, and Participants: </bold>This comparative effectiveness research study of adult Medicare beneficiaries who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis used instrumental-variable survival analysis to estimate the cumulative incidence of medication discontinuation and restart. Data analyses were performed from February to June 2021.<bold>Exposures: </bold>Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.<bold>Main Outcomes and Measures: </bold>The primary outcome was discontinuation of diabetes, hypertension, and hyperlipidemia medication for any reason. Among patients who discontinued medication, the adjusted cumulative incidence of restarting medication was calculated up to 5 years after discontinuation.<bold>Results: </bold>Of the 95 405 patients included, 71 348 (74.8%) were women and the mean (SD) age was 56.6 (11.8) years. Gastric bypass compared with sleeve gastrectomy was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30 588 patients with diabetes medication use and diagnosis at the time of surgery (74.7% [95% CI, 74.6%-74.9%] vs 72.0% [95% CI, 71.8%-72.2%]), 52 081 patients with antihypertensive medication use and diagnosis at the time of surgery (53.3% [95% CI, 53.2%-53.4%] vs 49.4% [95% CI, 49.3%-49.5%]), and 35 055 patients with lipid-lowering medication use and diagnosis at the time of surgery (64.6% [95% CI, 64.5%-64.8%] vs 61.2% [95% CI, 61.1%-61.3%]). Among the subset of patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. Specifically, the 5-year cumulative incidence of medication restart was lower after gastric bypass compared with sleeve gastrectomy among 19 599 patients who discontinued their diabetes medication after surgery (30.4% [95% CI, 30.2%-30.5%] vs 35.6% [95% CI, 35.4%-35.9%]), 21 611 patients who discontinued their antihypertensive medication after surgery (67.2% [95% CI, 66.9%-67.4%] vs 70.6% [95% CI, 70.3%-70.9%]), and 18 546 patients who discontinued their lipid-lowering medication after surgery (46.2% [95% CI, 46.2%-46.3%] vs 52.5% [95% CI, 52.2%-52.7%]).<bold>Conclusions and Relevance: </bold>Findings of this study suggest that, compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication. Long-term trials are needed to explain the mechanisms and factors associated with differences in medication discontinuation and comorbidity resolution after bariatric surgery.
- Subjects
UNITED States; BARIATRIC surgery; HYPERTENSION; ANTIHYPERTENSIVE agents; RESEARCH; RESEARCH methodology; MORBID obesity; EVALUATION research; HYPERLIPIDEMIA; GASTRECTOMY; TREATMENT effectiveness; COMPARATIVE studies; LAPAROSCOPY; WEIGHT loss; RESEARCH funding; GASTRIC bypass; LIPIDS; MEDICARE; COMORBIDITY; DISEASE complications
- Publication
JAMA Surgery, 2022, Vol 157, Issue 3, p248
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2021.6898