Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass
Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications. To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes. A 2010–2017 U.S. commercial insurance claims data set. We co...
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| Published in | Surgery for obesity and related diseases Vol. 17; no. 1; pp. 72 - 80 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.01.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1550-7289 1878-7533 1878-7533 |
| DOI | 10.1016/j.soard.2020.08.035 |
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| Abstract | Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications.
To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.
A 2010–2017 U.S. commercial insurance claims data set.
We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.
We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5–3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2–1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6–4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1–1.8)) at 1 year of follow-up, persisting at 3 years.
Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.
•Concurrent hiatal hernia repair with SG is associated with higher risk of reoperation•Concurrent hiatal hernia repair with RYGB is associated with higher risk of endoscopy |
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| AbstractList | Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications.
To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.
A 2010-2017 U.S. commercial insurance claims data set.
We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.
We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years.
Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk. Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications. To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes. A 2010–2017 U.S. commercial insurance claims data set. We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling. We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5–3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2–1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6–4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1–1.8)) at 1 year of follow-up, persisting at 3 years. Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk. •Concurrent hiatal hernia repair with SG is associated with higher risk of reoperation•Concurrent hiatal hernia repair with RYGB is associated with higher risk of endoscopy Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications.BACKGROUNDHiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications.To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.OBJECTIVESTo examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.A 2010-2017 U.S. commercial insurance claims data set.SETTINGA 2010-2017 U.S. commercial insurance claims data set.We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.METHODSWe conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years.RESULTSWe matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5-3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2-1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6-4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1-1.8)) at 1 year of follow-up, persisting at 3 years.Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.CONCLUSIONSConcurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk. |
| Author | Arterburn, David E. Lewis, Kristina H. Zhang, Fang Wallace, Jamie Argetsinger, Stephanie Dimick, Justin B. Callaway, Katherine Ross-Degnan, Dennis Fernandez, Adolfo Wharam, J. Frank |
| AuthorAffiliation | e Department of Surgery, University of Michigan, Ann Arbor, Michigan c Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts d Kaiser Permanente Washington Health Research Institute, Seattle, Washington b Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina a Department of Epidemiology & Prevention, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina |
| AuthorAffiliation_xml | – name: d Kaiser Permanente Washington Health Research Institute, Seattle, Washington – name: b Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina – name: a Department of Epidemiology & Prevention, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina – name: c Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts – name: e Department of Surgery, University of Michigan, Ann Arbor, Michigan |
| Author_xml | – sequence: 1 givenname: Kristina H. surname: Lewis fullname: Lewis, Kristina H. email: khlewis@wakehealth.edu organization: Department of Epidemiology & Prevention, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina – sequence: 2 givenname: Katherine surname: Callaway fullname: Callaway, Katherine organization: Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts – sequence: 3 givenname: Stephanie surname: Argetsinger fullname: Argetsinger, Stephanie organization: Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts – sequence: 4 givenname: Jamie surname: Wallace fullname: Wallace, Jamie organization: Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts – sequence: 5 givenname: David E. surname: Arterburn fullname: Arterburn, David E. organization: Kaiser Permanente Washington Health Research Institute, Seattle, Washington – sequence: 6 givenname: Fang surname: Zhang fullname: Zhang, Fang organization: Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts – sequence: 7 givenname: Adolfo surname: Fernandez fullname: Fernandez, Adolfo organization: Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina – sequence: 8 givenname: Dennis surname: Ross-Degnan fullname: Ross-Degnan, Dennis organization: Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts – sequence: 9 givenname: Justin B. surname: Dimick fullname: Dimick, Justin B. organization: Department of Surgery, University of Michigan, Ann Arbor, Michigan – sequence: 10 givenname: J. Frank surname: Wharam fullname: Wharam, J. Frank organization: Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts |
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| Copyright | 2020 American Society for Bariatric Surgery Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved. |
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| Keywords | Hiatal hernia repair Gastric bypass Sleeve gastrectomy |
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| Snippet | Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications.
To examine the... Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications. To examine the... Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease-related complications.BACKGROUNDHiatal... |
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| SubjectTerms | Adult Bariatric Surgery Gastrectomy Gastric Bypass Hernia, Hiatal - surgery Herniorrhaphy Hiatal hernia repair Humans Obesity, Morbid - complications Obesity, Morbid - surgery Retrospective Studies Sleeve gastrectomy |
| Title | Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass |
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