Panagiotou OA, et al. - In the Medicare-eligible population, experts evaluated the comparative effectiveness and safety of bariatric procedures. Low to moderate strength of evidence that bariatric surgery as a weight loss treatment improves non–weight loss outcomes were noted in the Medicare population.

Methods

• Researchers conducted a systematic review according to the PRISMA guidelines.
• They identified the articles through searches of PubMed, Embase, CINAHL, PsycINFO, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and scientific information packages from manufacturers, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and US Food and Drug Administration drugs and devices portals from January 1, 2000, to June 31, 2017.
• They noted the randomized and nonrandomized comparative studies that evaluated bariatric procedures in the Medicare-eligible population to be eligible.
• Data on design, interventions, outcomes, and study quality was extracted by 6 researchers.
• They synthesized the findings qualitatively; a planned meta-analysis was not undertaken owing to clinical heterogeneity.

Results

• As per data, a total of 11,455 citations were screened for eligibility.
• Out of those, eligibility criteria was met by 16.
• Greater weight loss was resulted by bariatric surgery compared with no surgery or conventional weight-loss treatment.
• Findings suggested lower overall mortality after 30 days among bariatric patients (hazard ratio, HR, 0.50; 95% CI, 0.31-0.79, in the study with the longest follow-up of 5.9 years), although, based on 1 study, mortality within 30 days of surgery was higher than in nonsurgically treated controls (1.55% vs 0.53%; P < .001).
• Results demonstrated the association of bariatric surgery with lower risk of cardiovascular disease (HR, 0.59; 95% CI, 0.44-0.79 in the largest study comparison) and with improvements in respiratory, musculoskeletal, metabolic, and renal outcomes (increase in estimated glomerular filtration rate, 9.84; 95% CI, 8.05-11.62 mL/min/1.73m2).
• Roux-en-Y gastric bypass (RYGB) appears to be associated with greater weight loss (percent excess weight loss, 23.8% [95% CI, 16.2%-31.4%] at the longest follow-up of 4 years) compared with sleeve gastrectomy (SG) and adjustable gastric banding (AGB), but the 3 procedures have similar associations with most non–weight loss outcomes.
• Overall postoperative complications are not statistically significantly different between RYGB and SG, although major and/or serious complications are more common after RYGB.
• However, these associations are susceptible to at least moderate risk of confounding, selection, or measurement biases.