ASMBS 2012 Top Papers: BOLD Data

Dr. John Morton presented one of the top 8 papers at today’s opening session of the 29th Annual Meeting of the American Society of Metabolic and Bariatric Surgery. The paper was an analysis from the BOLD database; he compared the gastric band (lap band), gastric bypass, and sleeve. The BOLD Database is a rich source of bariatric surgery data from 540 hospitals and 1200 surgeons, and this paper included data from over 117,000 band patients, 138,000 gastric bypass patients, and 16,000 sleeve patients. No single weight loss surgery is the best choice for all patients, so many surgeons believe in the importance of offering a range of procedures. This allows the experts to help each patient make the decision about surgery that is best for their own personal situation. Because of this, a top priority in the field of metabolic and bariatric surgery is understanding the data on the safety and efficacy of each operation.

There were several key points make in the study. Dr. Morton highlighted the fact that the pattern of improvement among each comorbidity was quite similar: each procedure improved comorbidities, but gastric bypass patients generally had the lowest prevalence of comorbidities after surgery. A safety profile of each procedure showed the band to have the strongest safety profile, and the bypass with the lowest safety profile, and the sleeve was in between. Dr Morton showed a validity comparison between the BOLD data and those from several other major data collection programs. In looking at the 30-day mortality rate, the BOLD data was very closely matched with the other databases. Dr. Jaime Ponce, President-Elect of ASMBS told us, “this is a great example of how the culture of reporting data has been adopted by bariatric surgeons. Reporting is the first step and using the data for quality improvement will be needed. This is certainly the largest database in bariatric surgery.” The authors’ conclusions from the data were that the sleeve gastrectomy falls between the lap band and gastric bypass in terms of both efficacy and safety. The lap band is generally the safest procedure, and the gastric bypass is generally the procedure that has the strongest effect on comorbidities.

In 2011, several studies showed benefits of sleeve gastrectomy. Additionally, a course last year discussed the potential of the sleeve to be a metabolic surgery. Currently, CMS is making a decision about whether Medicare will add the sleeve gastrectomy to the bariatric and metabolic procedures it covers.