Weight loss after laparoscopic adjustable gastric banding: the role of race, BMI and age
Dalmar A, Chua TY, Singh M. Weight loss after laparoscopic adjustable gastric banding: the role of race, BMI and age. J Patient-Centered Res Rev. 2014;1:61.
Presented at 2013 Aurora Scientific Day, Milwaukee, WI
Background/significance: Laparoscopic adjustable Gastric Banding (LAGB) has become one of the most common bariatric surgery procedures performed in the United States since its approval in 2001. According to the latest bariatric surgery studies, there is no disparity in the use of bariatric surgery by race. However, recently, it has been hypothesized that race, BMI and age may affect the outcome after bariatric surgery. Aurora Sinai Bariatric Surgery Center of excellence, with its single surgeon, has gathered a data of 852 patients who underwent LAGB from 2001 to 2010.
Purpose: To determine the difference in mean percentage of excess weight loss (% EWL) for 5 years after LAGB among African Americans (AA) and Caucasians.
Methods: IRB approval was obtained to conduct a retrospective review of prospectively collected data for 852 patients who underwent a LAGB from February 2001 to February 2010. Included in the analysis were only 721 patients with pars flaccida technique. The initial technique, Perigastric, was abandoned after first 90 cases because of high frequency of complications. Demographics, preoperative comorbidities, operative time (OR), length of stay (LOS) and mean % EWL at 1, 2, 3, 4, 5 years, were compared. T-test was used to determine the mean % EWL difference between AA and Caucasians. Univariate analysis was done to compare mean % EWL across race (AA and Caucasians), age (<50, ≥50 years) and BMI (<50, ≥50 kg/m2).
Results: Data from 721 (82% females, 78% Caucasians) patients were analyzed. Overall AA were younger with higher BMI. Median operating room time was 59 mins for AA and 62 mins for Caucasians. Ninety-nine percent of AA and 73% of Caucasians had 1 or more comorbidities. The mean % EWL was significantly higher for Caucasians compared to AA for 1st and 2nd year intervals (27.7±14.9 vs. 21.5±12.2 for first year and 38.7±19.1 vs. 32.7±20.0 for second year). No significant difference in mean % EWL at 3, 4 and 5 years follow up. The only significant interaction was between age and BMI indicating that the mean % EWL in the first year was higher for younger and lighter patients. There is also a trend in interaction between race and BMI indicating that Caucasians lost more weight than AA only if they had lower BMI.
Conclusion: Although race is a factor in determining mean % EWL in the first and second years after surgery, the combination of BMI and age groups also may play an important role in weight loss after LAGB.