Use and Outcomes of Laparoscopic Versus Open Gastric Bypass at Academic Medical Centers

BackgroundA large outcome study of laparoscopic gastric bypass has not been done because of difficulty in differentiating between open and laparoscopic procedures in the absence of a specific ICD-9 procedural code for the laparoscopic operation. The University HealthSystem Consortium (UHC) clinical database recently added a specific procedural code for laparoscopic gastric bypass. The goal of this study was to compare the use and outcomes of laparoscopic versus open gastric bypass at academic centers.Study DesignUsing ICD-9 diagnosis and procedure codes, we obtained data from the UHC clinical database for all patients who underwent laparoscopic or open Roux-en-Y gastric bypass for treatment of morbid obesity between 2004 and 2006 (n = 22,422). The main outcomes measures were demographics, comorbidities, length of hospital stay, 30-day readmission, morbidity, observed and expected (risk-adjusted) mortality, and costs.ResultsThere were 16,357 patients who underwent laparoscopic gastric bypass and 6,065 patients who underwent open gastric bypass. Laparoscopic gastric bypass patients had a shorter length of hospital stay (2.7 days versus 4.0 days, p < 0.01); lower overall complications (7.4% versus 13.0%, p < 0.01); lower rates of pneumonia, venous thrombosis, leak, wound infection, and pulmonary complications; costs were also lower. The observed-to-expected in-hospital mortality ratio was similar between groups (1.0 versus 1.0).ConclusionsThis nationwide analysis of academic medical centers between 2004 and 2006 showed that bariatric surgery has shifted to a predominately laparoscopic approach. In addition, laparoscopic gastric bypass is as safe as open gastric bypass and is considerably associated with a lower 30-day morbidity.