OBJECTIVES: Reoperative bariatric surgeries (BxS) may be used to address BxS-related complications or inadequate weight loss. There is a paucity of data regarding whether the historical incidence of reoperations varied by previous/initial BxS type (laparoscopic: adjustable gastric banding [LAGB], Roux-en-Y gastric bypass [LRYGB], sleeve gastrectomy [LSG]).

METHODS: Retrospective, observational study using administrative claims data (Truven Health MarketScan). Study patients underwent BxS (LAGB/LRYGB/LSG) between 1/1/2007-9/1/2015. For each patient and BxS type, the first occurrence of that surgery type was designated as an index date. Patients could have up-to 2 index dates: one for the first observed LAGB (rarely performed post-LSG/LRYGB), one for the first observed LSG/LRYGB (allowing for LAGB pre-LSG/LRYGB, which is common); patients had 1 year of continuous enrollment pre-index date(s). Patients were followed from their index date(s) until the first occurrence of a reoperation or censoring at insurance disenrollment or 9/30/2015. The Kaplan-Meier method was used to generate unadjusted probabilities of incident reoperation over time post index.

RESULTS: Study included 47,537 LAGB, 64,201 LRYGB, and 52,815 LSG patients (mean age 44-45 years; 77-79% female). Kaplan-Meier-estimated accumulative unadjusted probabilities of reoperation at 1/3/5/7 years post-index were: LABG, 1y=6.7%, 3y=15.5%, 5y=24.2%, 7y=31.3%; LRYBG, 1y=1.4%, 3y=3.2%, 5y=4.5%, 7y=6.1%; LSG, 1y=0.7%, 3y=1.6%, 5y=2.7%, 7y=undefined/inadequate follow-up. The most common reoperations involved: band revision/removal/replacement for LAGB (66.2% of 6,745 reoperations in LAGB cohort); conversion to LRYGB (27.6% of 464 reoperations) for LSG; miscellaneous procedures (47.3% of 1,591 reoperations) for LRYGB. Common diagnoses associated with the reoperations, other than obesity, involved a variety of digestive/band/device complications and gastrointestinal symptoms (e.g., reflux/dysphagia/pain).

CONCLUSIONS: Across all BxS types, the historical rate of reoperations appears to have been driven by band-related revisions and complication-related factors. Given that LAGB has become rare in the U.S., research on the predictors of reoperation after LSG/LRYGB may inform improved BxS patient management practices.