Evolving Trends in North American Gastric Bypass Delivery: a Retrospective MBSAQIP Analysis of Technical Factors and Outcomes from 2015 to 2018.

A number of procedural and technical factors have been adopted over time to overcome the steep learning curve and adverse safety profile of Roux-en-Y gastric bypass (RYGB). However, the evolution and impact of these factors are not currently known which limits our ability to optimize RYGB delivery. Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2018. All primary RYGB procedures were included while prior revisional surgeries and emergency surgeries were excluded. Primary outcomes included characterizing the trends in procedural and technical factors associated with RYGB. A total of 156,941 patients underwent primary RYGB from 2015 to 2018 with a mean age of 45.2 ± 11.9 years and a mean body mass index of 46.4 ± 8.4 kg/m [1]. The majority of patients were female (80.3%), of white racial status (73.5%), and of non-smoking status (92.1%). The most commonly performed approach was laparoscopic RYGB although an increase in robotic cases was observed over time. Rates of drain placement and postoperative swallow studies decreased by 10% from 2015 to 2018. Together, these trends were associated with reductions in serious complications, readmission, and re-intervention rates over time. The proportion of RYGB cases performed in MBSAQIP accredited centers has decreased from 2015 to 2018 associated with an increased adoption of sleeve gastrectomy Leaks, serious complications, readmission, and reintervention rates improved with each operative year suggesting that the technical proficiency and safety of RYGB continue to evolve with time.