TOPLINE

An analysis of over 1 million bariatric procedures shows a significant decline in total procedure volume from 2022 to 2024, with per-center volumes falling to pandemic-era levels by 2024. Practice patterns are shifting toward more complex conversion procedures, serious complication rates are declining, and mortality remains stable despite rising patient complexity.

METHODOLOGY

• Researchers evaluated 5-year trends in bariatric surgery practice patterns and outcomes by conducting retrospective analysis of data from a national database from 2020 to 2024.
• Over 1 million bariatric procedures were analyzed, including primary, conversion, and revision bariatric operations performed at accredited centers in the United States and Canada.
• Conversion procedure involved switching from one bariatric surgery type to a completely different one. Revision, by contrast, involves adjusting or correcting the original procedure — typically to manage complications or insufficient results — while keeping the same overall procedure type intact.
• The primary outcomes included characterizing 5-year trends in delivery procedure. Secondary outcomes included rates of complications, readmissions, and mortality.

TAKEAWAY

• Total annual procedure volumes peaked at 230,707 in 2022 before declining to 177,789 in 2024, representing a 23% decrease, with average case-volume per-center falling from 250 cases at peak to 185 cases in 2024 despite an increase in accredited centers from 885 in 2020 to 959 in 2024.
• Patient complexity increased significantly, with proportion of patients in American Society of Anesthesiologists Class III or higher rising from 79.77% to 82.45%, sleep apnea from 36.36% to 37.63%, hyperlipidemia from 22.17% to 23.28%, history of venous thromboembolism from 2.61% to 3.05%, and therapeutic anticoagulation use at the time of surgery from 2.89% to 3.36% (all P < .0001).
• The rates of serious complication declined from 3.39% to 3.10%, reoperation rates decreased from 1.20% to 1.10% (P < .0001 for both), and mortality remained stable at 0.08% to 0.06%, while 30-day readmission rates increased from 3.2% to 3.6% (P < .0001).
• The rates of sleeve gastrectomy declined from 73.4% to 70.6% of primary procedures while that of Roux-en-Y gastric bypass increased from 26.6% to 29.4% (P < .0001 for both).

IN PRACTICE

"These findings demonstrate the evolving role of bariatric surgery in a landscape shaped by pharmacologic alternatives, post-pandemic recovery dynamics, and persistent access barriers," wrote the authors of the study.

SOURCE

The study was led by Mélissa V. Wills, Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland. It was published online on July 15 in Obesity Surgery.

LIMITATIONS

The retrospective database design limits assessment of granular clinical details such as preoperative laboratory values, medications, and long-term outcomes beyond 30 days. The study did not capture data for surgeon-level experience and volume, as well as geographic variation in practice patterns, insurance requirements, and patient demographics. With a large sample size, even small effect sizes can reach statistical significance — an inherent drawback of relying on registry-based data.

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.