National usage of bariatric surgery for class I obesity: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

Theresa N Jackson; Bradley P Cox; Gary G Grinberg; Panduranga R Yenumula; Robert B Lim; Geoffrey S Chow; Zhamak Khorgami

doi:10.1016/j.soard.2023.05.014

National usage of bariatric surgery for class I obesity: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

Surg Obes Relat Dis. 2023 Nov;19(11):1255-1262. doi: 10.1016/j.soard.2023.05.014. Epub 2023 May 22.

Authors

Theresa N Jackson¹, Bradley P Cox², Gary G Grinberg³, Panduranga R Yenumula³, Robert B Lim², Geoffrey S Chow², Zhamak Khorgami⁴

Affiliations

¹ Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California. Electronic address: theresa.n.jackson@gmail.com.
² Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma.
³ Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California.
⁴ Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

PMID: 37438232
DOI: 10.1016/j.soard.2023.05.014

Abstract

Background: National and international consensus statements, as well as the National Institutes of Health (NIH), support the use of bariatric surgery for the treatment of class I obesity. Despite this, most payors within the United States limit reimbursement to the outdated 1991 NIH guidelines or a similar adaptation.

Objectives: This study aimed to determine the safety of bariatric surgery in patients with lower BMI compared with standard patients, as well as determine U.S. utilization of bariatric surgery in class I obesity in 2015-2019.

Setting: A retrospective analysis was performed of the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

Methods: Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass patients were divided into body mass index cohorts: class I obesity (<35 kg/m²) and severe obesity (≥35 kg/m²). Differences in preoperative patient selection and postoperative outcomes were established, and frequency trends were delineated.

Results: Analysis included 760,192 surgeries with 8129 (1%) for patients with class I obesity. The patients with class I obesity were older, more commonly female, and with lower American Society of Anesthesiologists (ASA) class, but with higher rates of type 2 diabetes, hyperlipidemia, and gastroesophageal reflux disease (P < .05). Variation was found for operative time, length of stay, 30-day readmission, and composite morbidity. Minimal annual variation was found for bariatric surgeries performed for patients with class I obesity.

Conclusions: The short-term safety of bariatric surgery in patients with class I obesity was corroborated by this study. Despite consensus statements and robust support, rates of bariatric surgery in patients with class I obesity have failed to increase and remain limited to 1%. This demonstrates the impact of the outdated 1991 NIH guidelines regarding access to care for these potentially life-saving surgeries.

Keywords: Bariatric surgery; Class I obesity; Gastric bypass; Guideline; Low BMI; Roux-en-Y gastric bypass; Sleeve gastrectomy.