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1 Supplementary Online Content Arterburn D, Powers JD, Toh S, et al. Comparative effectiveness of laparoscopic adjustable gastric banding vs laparoscopic gastric bypass. JAMA Surg. Published online October,. doi:./jamasurg..7. etable. Healthcare Common Procedure Coding System (HCPC), International Classification of Diseases, Ninth Revision, Clinical Modification (-CM), and Current Procedure Terminology () Codes etable. Frequency of Subsequent Interventions Occurring During Long-term Followup After Initial Bariatric Procedure by Surgery Type etable. Frequency of Major Adverse Events Occurring Within Days After Initial Bariatric Procedure by Surgery Type efigure. Cumulative Incidence of Subsequent Intervention After Bariatric Surgery by AGB vs RYGB Procedure Type, Including Gastric Endoscopic Procedures efigure. Identification of Study Participants Who Underwent Laparoscopic Adjustable Gastric Banding or Roux-en-Y Gastric Bypass Between and in Health Care Systems This supplementary material has been provided by the authors to give readers additional information about their work. Downloaded From: on 7//8

2 etable. Healthcare Common Procedure Coding System (HCPC), International Classification of Diseases, Ninth Revision, Clinical Modification (-CM), and Current Procedure Terminology () Codes Primary Bariatric Procedure definition Laparoscopic AGB: HCPC: S8; : 77; Code:. Laparoscopic RYGB: HCPC: S8; : 8,, ; Code:.8) For patients with laparoscopic RYGB procedure code.8, a diagnosis of morbid obesity ( diagnosis code 78.) must have occurred during the same encounter. Deep Vein Thrombosis definition Dx Code Description PHLEBITIS AND THROMBOPHLEBITIS OF LOWER EXTREMITIES,. UNSPECIFIED.8 PHLEBITIS AND THROMBOPHLEBITIS OF ILIAC VEIN PHLEBITIS AND THROMBOPHLEBITIS OF DEEP VEINS OF UPPER.8 EXTREMITIES PHLEBITIS AND THROMBOPHLEBITIS OF UPPER EXTREMITIES,.8 UNSPECIFIED.8 PHLEBITIS AND THROMBOPHLEBITIS OF SITE. PHLEBITIS AND THROMBOPHLEBITIS OF UNSPECIFIED SITE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF. LOWER EXTREMITY VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP. VESSELS OF LOWER EX VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF. PROXIMAL LOWER EXTRE VENOUS EMBOLISM & THROMBOSIS OF DEEP VESSELS OF. DISTAL LOWER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF.8 SPECIFIED VEINS DEEP PHLEBOTHROMBOSIS, ANTEPARTUM, UNSPECIFIED AS TO 7. EPISODE OF CARE 7. DEEP PHLEBOTHROMBOSIS, ANTEPARTUM, WITH DELIVERY 7. Deep phlebothrombosis, antepartum, delivered, with mention of postpart 7. DEEP PHLEBOTHROMBOSIS, ANTEPARTUM 7. Deep phlebothrombosis, antepartum, postpartum condition or complication 7. Deep phlebothrombosis, antepartum DEEP PHLEBOTHROMBOSIS, POSTPARTUM, UNSPECIFIED AS TO 7. EPISODE OF CARE 7. DEEP PHLEBOTHROMBOSIS, POSTPARTUM, WITH DELIVERY Downloaded From: on 7//8

3 7. Deep phlebothrombosis, postpartum, antepartum condition or complication UNSPECIFIED VENOUS COMPLICATION OF PREGNANCY AND 7. THE PUERPERIUM, UNSPE UNSPECIFIED VENOUS COMPLICATION, WITH DELIVERY, WITH 7. OR WITHOUT MENTIO UNSPECIFIED VENOUS COMPLICATION, WITH DELIVERY, WITH 7. MENTION OF POSTPA 7. UNSPECIFIED VENOUS COMPLICATION, ANTEPARTUM 7. UNSPECIFIED VENOUS COMPLICATION, POSTPARTUM OBSTETRICAL BLOOD-CLOT EMBOLISM, WITH DELIVERY, WITH 7. OR WITHOUT MENTIO OBSTETRICAL BLOOD-CLOT EMBOLISM, WITH MENTION OF 7. POSTPARTUM COMPLICATI 7. OBSTETRICAL BLOOD-CLOT EMBOLISM, ANTEPARTUM 7. OBSTETRICAL BLOOD-CLOT EMBOLISM, POSTPARTUM Pulmonary Embolism definition Dx Code Description. PULMONARY EMBOLISM AND INFARCTION. IATROGENIC PULMONARY EMBOLISM AND INFARCTION. SEPTIC PULMONARY EMBOLISM. Pulmonary embolism and infarction. PULMONARY EMBOLISM AND INFARCTION. CHRONIC PULMONARY EMBOLISM. THROMBOPHLEBITIS MIGRANS VENOUS EMBOLISM AND THROMBOSIS, OF. INFERIOR VENA CAVA. EMBOLISM AND THROMBOSIS OF UNSPECIFIED SITE EMBOLISM FOLLOWING ABORTION OR ECTOPIC AND. MOLAR PREGNANCIES 7. OBSTETRICAL BLOOD-CLOT EMBOLISM Bariatric re-intervention definition* Name Code Type CPT - /ICD - Cod e Description AGB REMOVAL 77 LAP RMVL GASTR ADJ DEVICE Downloaded From: on 7//8

4 AGB REMOVAL AGB REMOVAL AGB REMOVAL AGB REVISION AGB REVISION AGB REVISION LAP RMVL GASTR ADJ ALL PARTS REMOVE GASTRIC PORT, OPEN LAPAROSCOPIC REMOVAL OF GASTRIC RESTRICTIVE DEVICE(S) LAP REPLACE GASTR ADJ DEVICE CHANGE GASTRIC PORT, OPEN LAP REVISE GASTR ADJ DEVICE REVISE GASTRIC PORT, OPEN LAPAROSCOPIC REVISION OF GASTRIC RESTRICTIVE PROCEDURE ESOPH SCOPE W/SCLEROSIS INJ ESOPHAGUS /LESION ESOPHAGUS ESOPHAGUS, DILATIO ESOPH, REPAIR ESOPHAGUS, ABLATIO ESOPH W/US FN BX UPPER GI, EXAM UPPER GI, DIAGNOSI UP GI ENDO ESOPH STOMCH;SUBMCOS INJ UPPER GI, BIOPSY Downloaded From: on 7//8

5 UPPER GI & INJECT. UPPR GI SCOPE DILATE STRICTR PLACE GASTROS TUBE OPERATIVE UPPER GI UPPER GI /GUIDEWIRE ESOPHAGUS, DILATIO OPERATIVE UPPER GI OPERATIVE UPPER GI UP GI ENDO;THRM ENRGY MUSC LW ESOPH OPERATIVE UPPER GI ESOPHAGUS ESOPHGSCPY; DIR SUBMUCOS INJ SBSTNC ESOPHAGUS, BIOPSY ESOPHAGUS ESOPHAGUS ESOPHAGUS, DILATIO UPPR GI W/STENT Operative esophagoscopy by incision Esophagoscopy through artificial stoma Other esophagoscopy Downloaded From: on 7//8

6 Closed [endoscopic] biopsy of esophagus Open biopsy of esophagus Other diagnostic procedures on esophagus DILATE ESOPHAGUS DILATE ESOPHAGUS DILATE ESOPHAGUS DILATE ESOPHAGUS ENDOSCOPIC DILATION OF PYLORUS ENDOSCOPIC CONTROL OF GASTRIC OR DUODENAL BLEEDING SMALL BOWEL SMALL BOWEL /BIOPSY SMALL BOWEL TRANSABDOMINAL OF SMALL INTESTINE OF SMALL INTESTINE THROUGH ARTIFICIAL STOMA OF SMALL INTESTINE CLOSED ENDOSCOPICâ BIOPSY OF SMALL INTESTINE REPAIR ABDOMINAL REPAIR INCISIONAL REREPAIR ABDOMINAL REPAIR INCISIONAL Downloaded From: on 7//8

7 REPAIR W/MESH REPAIR EPIGASTRIC REPAIR, EPIGASTRIC RPR UMBIL HERN, REDUC > YR RPR UMBIL HERN, BLOCK > YR REPAIR ABDOMINAL LAPARO REPAIR INITIAL LAPARO REPAIR RECUR LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN, OR EPIGASTRIC ; REDUCIBLE LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN, OR EPIGASTRIC ; REDUCIBLE; INCARCERATED OR STRANGULATED LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL ; REDUCIBLE LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL ; REDUCIBLE; INCARCERATED OR STRANGULATED LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL ; REDUCIBLE LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL ; REDUCIBLE; INCARCERATED OR Downloaded From: on 7//8

8 LAGB HCP C HCP C HCP C STRANGULATED LAPARO PROC, REPAIR SUTURE, SECONDARY, OF ABDOMINAL WALL FOR EVISCERATION OR DEHISCENCE Repair of hernia. Repair of other hernia of anterior abdominal wall (without graft or prosthesis). Incisional hernia repair. Repair of other hernia of anterior abdominal wall. Repair of other hernia of anterior abdominal wall with graft or prosthesis. Other open incisional hernia repair with graft or prosthesis. Laparoscopic incisional hernia repair with graft or prosthesis.. Other laparoscopic repair of other hernia of anterior abdominal wall with graft or prosthesis Other and open repair of other hernia of anterior abdominal wall with graft or prosthesis. Other hernia repair S7 S7 7 S8 77. LAP SURG; REPAIR INCI/VENTRL LAP SURG; IMPL MESH INC/VENTRL HERN LAP SURG; ADJ GASTRIC BAND LAP PLACE GASTR ADJ DEVICE LAPAROSCOPIC GASTRIC RESTRICTIVE PROCEDURE Downloaded From: on 7//8

9 LAP SLEEVE LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASAND ROUX-EN-Y GASTROENTEROSC (ROUX LIMB CM OR LESS) GASTRIC BYPASS FOR OBESITY LAPAROSCOPIC GASTROENTEROS LAP LONGITUDINAL GASTREC LAPAROSCOPY, GASTROS LAP, ENTEROLYSIS LAP, JEJUNOS LAPAROSCOPY, ENTEROLYSIS LAP, ENTEREC LAP RESECT S/INTESTINE, ADDL UNLISTED LAP PROC INTEST NO RECTUM EXPLORATION OF ABDOMEN REOPENING OF ABDOMEN EXPLORATION OF RETROPERITONEAL AREA DRAIN ABDOMINAL ABSCESS DRAIN ABDOMINAL ABSCESS OPEN DRAINAGE ABDOM ABSCESS PERCUT DRAIN ABDOM ABSCESS Downloaded From: on 7//8

10 OPEN AGB DRAIN, OPEN, RETROP ABSCESS PERCUT DRAIN RETROPER ABSCES DIAG LAPARO SEPARATE PROC LAPAROSCOPY, ASPIRATION LAPAROSCOPY, DRAINAGE LAPARO PROC, ABDM/PER/OMENT LAP GASTR RSTRC;BYPS&SM INTST RECON 8 GASTROPLASTY FOR OBESITY 8 GASTRIC BYPASS FOR OBESITY 7. HIGH GASTRIC BYPASS. GASTROENTEROS WITHOUT GASTREC 8 GASTRIC REVISION FOR OBESITY LAPAROSCOPE PROC, STOM. REPAIR OF STOMACH.8 Insertion of permanent tube into esophagus.8 Repair of esophageal fistula, not elsewhere classified. Other operations on esophagus. DILATION OF ESOPHAGUS. GASTRO. PERCUTANEOUS (ENDOSCOPIC) GASTROS (PEG) Downloaded From: on 7//8

11 . GASTROS. LOCAL EXCISION OF LESION OR TISSUE OF STOMACH. PARTIAL GASTREC WITH ANASTOMOSIS TO ESOPHAGUS.7 PARTIAL GASTREC WITH ANASTOMOSIS TO JEJUNUM. TOTAL GASTREC REPAIR OF ESOPHAGUS REPAIR ESOPHAGUS AND FISTULA REPAIR OF ESOPHAGUS REPAIR ESOPHAGUS AND FISTULA SURGICAL OPENING OF STOMACH REMOVAL OF STOMACH, PARTIAL 7 NASAL/OROGASTRIC W/STENT 8 PLACE GASTROS TUBE 8 REPAIR OF STOMACH LESION 8 REVISE STOMACH-BOWEL FUSION 87 REPAIR STOMACH OPENING 88 REPAIR STOMACH-BOWEL FISTULA STOMACH SURGERY PROCEDURE. GASTROSCOPY. PYLOROPLASTY Downloaded From: on 7//8

12 . CONTROL OF HEMORRHAGE OF STOMACH OR DUODENUM. REVISION OF GASTRIC ANASTOMOSIS. CLOSURE OF GASTROS. CLOSURE OF GASTRIC FISTULA. INSERTION OF GASTRIC BUBBLE (BALLOON). OPERATIONS ON STOMACH FREEING OF BOWEL ADHESION DECOMPRESS SMALL BOWEL REDUCE BOWEL OBSTRUCTION CORRECT MALROTATION OF BOWEL REMOVAL OF SMALL INTESTINE REMOVAL OF SMALL INTESTINE REMOVAL OF SMALL INTESTINE BOWEL TO BOWEL FUSION INTRO, GASTROINTESTINAL TUBE SUTURE, SMALL INTESTINE REPAIR BOWEL OPENING 7 INTESTINE SURGERY PROCEDURE. INCISION OF SMALL INTESTINE. DIAGNOSTIC PROCEDURES Downloaded From: on 7//8

13 ON SMALL INTESTINE. MULTIPLE SEGMENTAL RESECTION OF SMALL INTESTINE. PARTIAL RESECTION OF SMALL INTESTINE. SMALL-TO-SMALL INTESTINAL ANASTOMOSIS. ENTEROS. FIXATION OF SMALL INTESTINE.7 SUTURE OF LACERATION OF DUODENUM.7 SUTURE OF LACERATION OF SMALL INTESTINE, EXCEPT DUODENUM.7 SUTURE OF LACERATION OF LARGE INTESTINE.7 REPAIR OF INTESTINE INTRA-ABDOMINAL MANIPULATION OF SMALL INTESTINE INTRA-ABDOMINAL MANIPULATION OF LARGE INTESTINE DILATION OF INTESTINE REVISION OF ANASTOMOSIS OF SMALL INTESTINE OPERATIONS ON INTESTINES DRAINAGE OF ABDOMEN PUNCTURE, PERITONEAL CAVITY PLACE GASTROS TUBE PERC PLACE DUOD/JEJ TUBE PERC Downloaded From: on 7//8

14 PEG TUBE PEG TUBE PEG TUBE PEG TUBE REVISION NOS REVISION NOS RYGB: LAP VBG VBG HCP C S CHANGE G-TUBE TO G-J PERC REPLACE DUOD/JEJ TUBE PERC ABDOMEN SURGERY PROCEDURE REMOVAL STOMACH, PARTIAL GASTRIC BYPASS FOR OBESITY PLACE GASTROS TUBE CHANGE GASTROS TUBE REPOSITION GASTROS TUBE SMALL BOWEL REVISION GASTROPLASTY REV GASTROJEJ ANASTOM; W/O VAGOT LAP GASTR RESTIRCT PROC W/GASTR BYP PARTIAL GASTREC GASTROPLASTY FOR OBESITY LAPAROSCOPIC GASTROPLASTY Endoscopy procedures were not included in our primary analyses related to reintervention; they are included in the analysis presented in efigure Downloaded From: on 7//8

15 etable. Frequency of Subsequent Interventions Occurring During Long-term Followup After Initial Bariatric Procedure by Surgery Type Subsequent Intervention N AGB % N % N Total % Total Category a AGB RYGB RYGB Other 7.% 7.7%.8% Hernia.%.% 7.% Laparoscopy/laparotomy.% 78.% 8.% Repeat bariatric procedure.%.%.8% AGB Revision 8.%.%.% AGB Removal.%.% 7.% Revision NOS.%.%.% PEG tube.% 8.% 8.% Occurrence of any reinterventions, excluding.7% 8.8% 8.88% endoscopy Endoscopy procedures b.7% 7.%.% Occurrence of any reinterventions, with endoscopy procedures b 8.% 7.%.% Abbreviations: AGB, adjustable gastric banding; NOS, not otherwise specified; PEG, percutaneous endoscopy gastrostomy; RYGB, Roux-en-Y gastric bypass. a Median follow-up (years) =. for AGB,. for RYGB, and. for total. b Endoscopy procedures were excluded from our primary analysis of reintervention outcome (Figure ), but are included in the outcome definition for efigure. Downloaded From: on 7//8

16 etable. Frequency of Major Adverse Events Occurring Within Days After Initial Bariatric Procedure by Surgery Type Major adverse events Failure to discharge Number AGB Percent AGB Number RYGB Percent RYGB Number Total Percent Total.% 8.% 8.% Reintervention.7%.%.7% DVT/PE*.%.7% 8.7% Death.%.%.% Total Adverse Events.% 7.% 8.7% Abbreviations: AGB, adjustable gastric banding; DVT, deep vein thrombosis; PE, pulmonary embolism; RYGB, Roux-en-Y gastric bypass. Downloaded From: on 7//8

17 efigure. Cumulative Incidence of Subsequent Intervention After Bariatric Surgery by AGB vs RYGB Procedure Type, Including Gastric Endoscopic Procedures Reintervention includes any abdominal surgical intervention, repeat bariatric procedure or revisional procedure, removal of band, gastric endoscopic procedure, percutaneous gastrostomy tube placement. In the unadjusted model, the hazard ratio comparing AGB to RYGB patients experiencing a long-term reintervention (with gastric endoscopic procedure) was.8 (% CI,.7-.; P =.), favoring RYGB. In the propensity score-adjusted model, the hazard ratio was. (% CI,.-.7; P =.). AGB indicates adjustable gastric band; RYGB, Roux-en-Y gastric bypass. Propensity score adjusted between procedure comparison P =.. Downloaded From: on 7//8

18 efigure. Identification of Study Participants Who Underwent Laparoscopic Adjustable Gastric Banding or Roux-en-Y Gastric Bypass Between and in Health Care Systems Total number of bariatric cases identified* n =, No pre surgical BMI data available n =,77 Bariatric Cases with Pre Surgical BMI Data Available n = 7,7 Bariatric Cases with + BMI measures within years after surgery n = 7,7 Bariatric Cases with mortality data for adverse event analyses n =, < post surgical BMI measures available n = 77 No mortality data for adverse event analyses n = *Inclusion criteria = age years or older, enrolled for at least year prior to surgery date, underwent laparoscopic AGB or RYGB procedure, no prior bariatric procedure identified, maximum pre-surgical BMI kg/m ; BMI = body mass index Downloaded From: on 7//8