Background

Since 2012 a series of increasingly expanded guidelines supporting metabolic bariatric surgery (MBS) in patients with class 1 obesity (C1O) (BMI 30-35) have been published, but the impact on clinical practice is unknown. We sought to analyze national trends in MBS for CO during this time period.

Methods

The Metabolic Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) data were queried. MBS utilization in C1O and 30-day outcomes were evaluated using univariate and multivariate analyses.

Results

38,669 (3.5%) patients with C1O and 1,067,094 (96.5%) patients with BMI>35 were identified. Patient with C1O were younger 49y vs 44y (p<0.01), and predominantly white 76% vs 70% (p<0.01). The trends in MBS for C1O showed no significant increase indexed to total MBS cases, remaining at approximately 3.5% of all MBS procedures per year (p=NS). Trends in utilization of MBS for C1O with and without diabetes showed similar minimal change over time. The utilization of sleeve gastrectomy increased 6%, adjustable gastric band decreased 5.6%, and robotic use increased 15% during the study period (p<0.01, see Figure). On univariate analysis C1O had fewer superficial infections, more reoperations, and decreased mortality (all p<0.01), but no difference in these outcomes on multivariate regression.

Conclusions

Despite the expansion of guidelines supporting MBS in patients with class 1 obesity, there has been little corresponding increase in utilization in this population in recent years. Further analysis is needed to identify patient, provider, and system level factors that may be serving as barriers to increased access to MBS in this population.