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Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence

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Abstract

CONTEXT

Use of bariatric surgery for severe obesity has increased dramatically.

OBJECTIVE

To systematically review 1. the clinical efficacy and safety, 2. cost-effectiveness of bariatric surgery, and 3. the association between number of surgeries performed (surgical volume) and outcomes.

DATA SOURCES

MEDLINE (from 1950), EMBASE (from 1980), CENTRAL, EconLit, EURON EED, Harvard Center for Risk Analysis, trial registries and HTA websites were searched to January 2011.

STUDY SELECTION

1. Randomized controlled trials (RCTs) and 2. cost-utility and cost-minimisation studies comparing a contemporary bariatric surgery (i.e., adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) to another contemporary surgical comparator or a non-surgical treatment or 3. Any study reporting the association between surgical volume and outcome.

DATA EXTRACTION

Outcomes included changes in weight and obesity-related comorbidity, quality of life and mortality, surgical complications, resource utilization, and incremental cost-utility.

RESULTS

RCT data evaluating mortality and obesity-related comorbidity endpoints were lacking. A small RCT of 16 patients reported that adjustable gastric banding reduced weight by 27% (p < 0.01) compared to diet-treated controls over 40 weeks. Six small RCTs reported comparisons of commonly used, contemporary procedures. Gastric banding reduced weight to a lower extent than gastric bypass and sleeve gastrectomy and resulted in shorter operating times, fewer serious complications, lower weight loss efficacy, and more frequent reoperations compared to gastric bypass. Sleeve gastrectomy and gastric bypass reduced weight to a similar extent. A 2-year RCT in 50 adolescents reported that gastric banding substantially reduced weight compared to lifestyle modification (35 kg vs. 3 kg; p <0.001). Based on findings of 14 observational studies, higher volume centers and surgeons had lower mortality and complication rates. Surgery resulted in long-term incremental cost–utility ratios of $ <1.000–$40,000 (2009 USD) per quality-adjusted-life-year compared with non-surgical treatment.

CONCLUSIONS

Contemporary bariatric surgery appears to result in sustained weight reduction with acceptable costs but rigorous, longer-term (≥5 year) data are needed and a paucity of RCT data on mortality and obesity related comorbidity is evident. Procedure-specific variations in efficacy and risks exist and require further study to clarify the specific indications for and advantages of different procedures.

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References

  1. Samuel I, Mason E, Renquist K, Huang Y, Zimmerman M, Jamal M. Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry. Am J Surg. 2006;192(5):657–62. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/17071202

    Article  PubMed  Google Scholar 

  2. Buchwald H, Oien DM. Metabolic/Bariatric Surgery Worldwide 2008. Obes Surg. 2009;19:1605–11. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=19885707

    Article  PubMed  Google Scholar 

  3. Lau D, Douketis J, Morrison K, Hramiak I. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ. 2007;176[Suppl 8]:1–117. Accessed: March 30, 2011. Available: http://www.cmaj.ca/cgi/content/full/176/8/S1/DC1

    Google Scholar 

  4. National Heart Lung and Blood Institute, National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. NIH Publication No. 98-4083. Bethesda, MD: 1998.

  5. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41. Accessed: March 30, 2011. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20071471

    Article  PubMed  CAS  Google Scholar 

  6. Jacobs P, Ohinmaa A, Lier D, Klarenbach S, Chuck A, Padwal R. Costing of alternative interventions for the treatment of morbid obesity. Alberta Health and Wellness Technical Report 2005

  7. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010;303(3):242–9. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=20071470

    Article  PubMed  CAS  Google Scholar 

  8. van Dam RM, Willett WC, Manson JE, Hu FB. The relationship between overweight in adolescence and premature death in women. Ann Intern Med. 2006;145(2):91–7. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16847291

    PubMed  Google Scholar 

  9. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. Accessed: March 30, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/15479938

    Article  PubMed  CAS  Google Scholar 

  10. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=19641201

    Article  Google Scholar 

  11. Hensrud D, Klein S. Extreme obesity: a new medical crisis in the United States. Mayo Clin Proc. 2006;81[Suppl 10]:S5–10. Accessed: March 30, 2011. Available: http://www.mayoclinicproceedings.com/content/81/10_Suppl/S5.full

    PubMed  Google Scholar 

  12. Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med. 2003;163(18):2146–8. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14557211

    Article  PubMed  Google Scholar 

  13. Klarenbach S, Padwal R, Wiebe N, Hazel M, Birch DW, Manns BJ, et al. Bariatric Surgery for Severe Obesity: Systematic review and economic evaluation [Internet]. Ottawa: Canadian Agency for Drugs and Technologies in Health 2010 (Technology report; no. 129). [cited 2011-04-11]. Available: http://www.cadth.ca/index.php/en/hta/reportspublications/search/publication/2667.

  14. Jadad AR, Moore RA, Carrol D, Jenkinson C, Reynolds JM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 1996;17:1–12.

    Article  PubMed  CAS  Google Scholar 

  15. Neumann PJ, Stone PW, Chapman RH, Sandberg EA, Bell CM. The quality of reporting in published cost-utility analyses, 1976–1997. Ann Intern Med. 2000;132(12):964–72. Accessed: March 30, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/10858180

    PubMed  CAS  Google Scholar 

  16. Heindorff H, Hougaard K, Larsen PN. Laparoscopic adjustable gastric band increases weight loss compared to dietary treatment: A randomized study (abstract). Obes Surg. 1997;7(4):300–1. Accessed: March 30, 2011. Available: http://www.springerlink.com/content/p015575564132351/fulltext.pdf

    Google Scholar 

  17. Campos GM, Rabl C, Peeva S, Ciovica R, Rao M, Schwarz J-M, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14(1):15–23. Accessed: March 30, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19838759

    Article  Google Scholar 

  18. Nguyen NT, Slone JA, Nguyen XM, Hartman JS, Hoyt DB. A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: Outcomes, quality of life, and costs. Ann Surg. 2009.

  19. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg. 2007;3(2):127–32. discussion 32–3.

    Google Scholar 

  20. Langer FB, Reza Hoda MA, Bohdjalian A, Felberbauer FX, Zacherl J, Wenzl E, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9. Accessed: March 30, 2011. Available: http://www.springerlink.com/content/v3770h11h7041755/

    Article  PubMed  CAS  Google Scholar 

  21. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.

    Article  PubMed  Google Scholar 

  22. Peterli R, Kern B, Peters T, Christoffel-Courtin C, Hendrickson P, Von Fle M. Obes Surg. 2009; Conference: International Federation for the Surgery of Obesity and metabolic disorders. XIV World Congress Paris France. Conference Start: 20090826 Conference End: 20090829. Conference Publication: (var.pagings). 19 (8):1046. Accessed: March 30, 2011. Available: http://www.springerlink.com/content/n058587153422277/fulltext.pdf

  23. Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41. Accessed: March 30, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19638921

    Article  PubMed  Google Scholar 

  24. Schilling PL, Davis MM, Albanese CT, Dutta S, Morton J. National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence. J Am Coll Surg. 2008;206(1):1–12. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=18155562

    Article  PubMed  Google Scholar 

  25. O'Brien PE, Sawyer SM, Laurie C, Brown WA, Skinner S, Veit F, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA. 2010;303(6):519–26. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=20145228

    Article  PubMed  Google Scholar 

  26. Livingston EH, Elliott AC, Hynan LS, Engel E. When policy meets statistics: the very real effect that questionable statistical analysis has on limiting health care access for bariatric surgery. Arch Surg. 2007;142(10):979–87. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/17938312

    Article  PubMed  Google Scholar 

  27. Murr MM, Martin T, Haines K, Torrella T, Dragotti R, Kandil A, et al. A state-wide review of contemporary outcomes of gastric bypass in Florida: does provider volume impact outcomes? Ann Surg. 2007;245(5):699–706.

    Article  PubMed  Google Scholar 

  28. Weller WE, Rosati C, Hannan EL. Relationship between surgeon and hospital volume and readmission after bariatric operation. J Am Coll Surg. 2007;204(3):383–91. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/17324771

    Article  PubMed  Google Scholar 

  29. Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers. Ann Surg. 2004;240(4):586–93. discussion 93–4.

    PubMed  Google Scholar 

  30. Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery. 2003;134(4):613–21; discussion 21–3. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/14605622

    Article  PubMed  Google Scholar 

  31. Parker M, Loewen M, Sullivan T, Yatco E, Cerabona T, Savino JA, et al. Predictors of outcome after obesity surgery in New York state from 1991 to 2003. Surg Endosc. 2007;21(9):1482–6. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/17404793

    Article  PubMed  CAS  Google Scholar 

  32. Carbonell AM, Lincourt AE, Matthews BD, Kercher KW, Sing RF, Heniford BT. National study of the effect of patient and hospital characteristics on bariatric surgery outcomes. Am Surg. 2005;71(4):308–14.

    PubMed  Google Scholar 

  33. Liu JH, Zingmond D, Etzioni DA, O'Connell JB, Maggard MA, Livingston EH, et al. Characterizing the performance and outcomes of obesity surgery in California. Am Surg. 2003;69(10):823–8. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/14570356

    PubMed  Google Scholar 

  34. Kelles SMB, Barreto SM, Guerra HL. Mortality and hospital stay after bariatric surgery in 2,167 patients: Influence of the surgeon expertise. Obes Surg. 2009;19 (9):1228–35. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19562422

    Article  PubMed  Google Scholar 

  35. Kohn GP, Galanko JA, Overby DW, Farrell TM. High case volumes and surgical fellowships are associated with improved outcomes for bariatric surgery patients: a justification of current credentialing initiatives for practice and training. J Am Coll Surg 2010;210(6):909–18. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/20510799

    Article  PubMed  Google Scholar 

  36. Chevallier JM, Paita M, Rodde-Dunet MH, Marty M, Nogues F, Slim K, et al. Predictive factors of outcome after gastric banding: A nationwide survey on the role of center activity and patients' behavior. Ann Surg. 2007;246(6):1034–9. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/18043107

    Article  PubMed  Google Scholar 

  37. Flum DR, Salem L, Elrod JAB, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. J Am Med Assoc. 2005;294(15):1903–8. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/16234496

    Article  CAS  Google Scholar 

  38. Lopez J, Sung J, Anderson W, Stone J, Gallagher S, Shapiro D, et al. Is bariatric surgery safe in academic centers? Am Surg. 2002;68(9):820–3.

    PubMed  Google Scholar 

  39. Smith MD, Patterson E, Wahed AS, Belle SH, Bessler M, Courcoulas AP, et al. Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) study. Surg Obes Relat Dis. 2010;6 (2):118–25. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848920/

    Article  PubMed  Google Scholar 

  40. Salem L, Devlin A, Sullivan SD, Flum DR. Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surg. 2008;4(1):26–32.

    Google Scholar 

  41. Ackroyd R, Mouiel J, Chevallier J-M, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):1488–503. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/17132416

    Article  PubMed  Google Scholar 

  42. Jensen C, Flum DR, Conference AC. The costs of nonsurgical and surgical weight loss interventions: is an ounce of prevention really worth a pound of cure? Surg. 2005;1(3):353–7.

    Google Scholar 

  43. Paxton JH, Matthews JB. The cost effectiveness of laparoscopic versus open gastric bypass surgery. Obes Surg. 2005;15(1):24–34. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/15760496

    Article  PubMed  Google Scholar 

  44. Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113(6):491–8.

    Article  PubMed  Google Scholar 

  45. Clegg AJ, Colquitt J, Sidhu MK, Royle P, Loveman E, Walker A. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess. 2002;6(12):1–153. Accessed: March 31, 2011. Available: http://www.hta.ac.uk/execsumm/summ612.shtml

    PubMed  CAS  Google Scholar 

  46. Keating CL, Dixon JB, Moodie ML, Peeters A, Bulfone L, Maglianno DJ, et al. Cost-effectiveness of surgically induced weight loss for the management of Type 2 Diabetes: Modeled lifetime analysis. Diabetes Care. 2009;32(4):567–74. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19171720

    Article  PubMed  Google Scholar 

  47. Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190, 215–357, iii–iv. Accessed: March 31, 2011. Available: http://www.hta.ac.uk/execsumm/summ1341.htm

    CAS  Google Scholar 

  48. Anselmino M, Bammer T, Fernandez Cebrian JM, Daoud F, Romagnoli G, Torres A. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II). Obes Surg. 2009;19(11):1542–9. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19756896

    Article  PubMed  Google Scholar 

  49. Campbell J, McGarry LA, Shikora SA, Hale BC, Lee JT, Weinstein MC. Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity. Am J Manag Care. 2010;16(7):e174–87. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/20645663

    PubMed  Google Scholar 

  50. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–9. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/20805271

    Article  PubMed  Google Scholar 

  51. Ikramuddin S, Klingman D, Swan T, Minshall ME. Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients. Am J Manag Care. 2009;15(9):607–15. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19747025

    PubMed  Google Scholar 

  52. McEwen LN, Coelho RB, Baumann LM, Bilik D, Nota-Kirby B, Herman WH. The cost, quality of life impact, and cost-utility of bariatric surgery in a managed care population. Obes Surg. 2010;20(7):919–28. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/20446053

    Article  PubMed  Google Scholar 

  53. Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992;146(4):473–81. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488412/

    PubMed  CAS  Google Scholar 

  54. Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgments. BMJ. 2004;329(7459):224–7. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC487742/

    Article  PubMed  Google Scholar 

  55. Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn't it increase at the rate of inflation? Arch Intern Med. 2003;163(14):1637–41. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12885677

    Article  PubMed  Google Scholar 

  56. Dixon JB, O'Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23. Accessed: March 30, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/18212316

    Article  PubMed  CAS  Google Scholar 

  57. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52. Accessed: March 30, 2011. Available: http://content.nejm.org/cgi/content/full/357/8/741

    Article  PubMed  Google Scholar 

  58. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. Accessed: March 30, 2011. Available: http://content.nejm.org/cgi/content/full/351/26/2683

    Article  PubMed  Google Scholar 

  59. Sjostrom L, Gummesson A, Sjostrom CD, Narbro K, Peltonen M, Wedel H, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Onc. 2009;10(7):653–62. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=19556163

    Article  Google Scholar 

  60. Karlsson J, Taft C, Rydén A, Sjöström L, Sullivan M. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes Relat Metab Disord. 2007;31(8):1248–61. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17356530

    Article  CAS  Google Scholar 

  61. Grunstein R, Stenlof K, Hedner J, Peltonen M, Karason K, Sjostrom L. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep. 2007;30:703–10.

    PubMed  Google Scholar 

  62. Dansinger M, Tatsioni A, Wong J, Chung M, Balk E. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147(1):41–50. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17606960

    PubMed  Google Scholar 

  63. Padwal R, Sharma AM. Treating severe obesity: Morbid weights and morbid waits. CMAJ. 2009;181:777–8. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=19687104

    Article  PubMed  Google Scholar 

  64. D'Agostino RB. The delayed-start study design. N Engl J Med. 2009;361(13):1304–6. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=19776413

    Article  PubMed  Google Scholar 

  65. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89(6):2608–15. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15181031

    Article  PubMed  CAS  Google Scholar 

  66. Mason ME, Jalagani H, Vinik AI. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005;34(1):25–33. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15823436

    Article  PubMed  Google Scholar 

  67. Robinson MK. Surgical treatment of obesity—weighing the facts. N Engl J Med. 2009;361(5):520–1. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=19641209

    Article  PubMed  CAS  Google Scholar 

  68. Inge TH, Zeller M, Harmon C, Helmrath M, Bean J, Modi A, et al. Teen-longitudinal assessment of bariatric surgery: methodological features of the first prospective multicenter study of adolescent bariatric surgery. J Pediatr Surg. 2007;42(11):1969–71. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=18022459

    Article  PubMed  Google Scholar 

  69. Treadwell J, Sun F, Schoelles K. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg. 2008;248:763–76.

    Article  PubMed  Google Scholar 

  70. Rand CS, Macgregor AM. Adolescents having obesity surgery: a 6-year follow-up. South Med J. 1994;87(12):1208–13. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7973919

    Article  PubMed  CAS  Google Scholar 

  71. Inge TH, Krebs NF, Garcia VF, Skelton JA, Guice KS, Strauss RS, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004;114(1):217–23. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15231931

    Article  PubMed  Google Scholar 

  72. Surgical Review Corporation. [cited February 1, 2010]; Available from: http://www.surgicalreview.org

  73. US Department of Health and Human Services. Centers for Medicare and Medicaid Services. [cited February 1, 2010]; Available from: http://www.cms.hhs.gov/MedicareApprovedFacilitie

  74. Livingston EH. Bariatric surgery outcomes at designated centers of excellence vs. nondesignated programs. Arch Surg. 2009;144(4):319–25; discussion 25. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19380644

    Article  PubMed  Google Scholar 

  75. Flum D, Khan T, Dellinger E. Toward the rational and equitable use of bariatric surgery. JAMA. 2007;298(12):1442–4. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17895461

    Article  PubMed  CAS  Google Scholar 

  76. Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes. 2009;33(3):289–95. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19188927

    Article  CAS  Google Scholar 

  77. Buchwald H, Estok R, Fahrbach K, Banel D. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009. Accessed: March 31, 2011. Available: http://www.ncbi.nlm.nih.gov/pubmed/19272486

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Acknowledgements

This study was performed by the Interdisciplinary Chronic Disease Collaboration. Funding was provided by the Canadian Agency for Drugs and Technologies in Health and the Alberta Heritage Foundation for Medical Research (AHFMR) Interdisciplinary Team Grants Program. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Padwal had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Drs. Tonelli and Klarenbach were supported by salary awards from AHFMR. Drs. Tonelli, Padwal and Klarenbach were supported by an alternative funding plan from the Government of Alberta and the University of Alberta.

Conflict of Interest

Dr. Sharma has received consultant and speaker fees from Ethicon Endosurgery, Covidien and Allergan. Drs. Padwal and Sharma have received research funding from Covidien.

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Authors and Affiliations

  1. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Raj Padwal MD MSc, Scott Klarenbach MD MSc, Natasha Wiebe MMath PStat, Maureen Hazel MA, Arya M. Sharma MD PhD & Marcello Tonelli MD SM

  2. Department of Surgery, University of Alberta, Edmonton, Alberta, Canada

    Daniel Birch MSc MD & Shahzeer Karmali MD

  3. Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Braden Manns MD MSc

  4. 2F1.26 Walter C. Mackenzie Health Sciences Centre, 8440-112th Street, Edmonton, Alberta, T6G 2B7, Canada

    Raj Padwal MD MSc

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  1. Raj Padwal MD MSc
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  2. Scott Klarenbach MD MSc
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  3. Natasha Wiebe MMath PStat
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  4. Maureen Hazel MA
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  5. Daniel Birch MSc MD
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  6. Shahzeer Karmali MD
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  7. Arya M. Sharma MD PhD
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  8. Braden Manns MD MSc
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  9. Marcello Tonelli MD SM
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Corresponding author

Correspondence to Raj Padwal MD MSc.

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Padwal, R., Klarenbach, S., Wiebe, N. et al. Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence. J GEN INTERN MED 26, 1183–1194 (2011). https://doi.org/10.1007/s11606-011-1721-x

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  • DOI: https://doi.org/10.1007/s11606-011-1721-x

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