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Comparative Safety of Sleeve Gastrectomy and Roux-en-Y: A Propensity Score Analysis

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Abstract

Background

Use of bariatric surgery has increased dramatically in the USA. However, there are growing concerns regarding the safety outcomes of different bariatric procedures. We aim to compare the safety of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), which includes hospital readmissions, emergency room (ER) visits, gastrointestinal bleeding, and revisional surgery.

Methods

A retrospective cohort analysis was conducted for adults (≥ 18 years) who received SG and RYGB in the USA. We used Truven MarketScan Commercial and Medicare supplemental claims databases from January 1, 2005, to October 1, 2015. To adjust for baseline demographic and clinical characteristics, we used stabilized inverse probability of treatment weighting using propensity score. Cox proportional hazard models was used to compare safety outcomes between SG and RYGB after bariatric surgery.

Results

A total of 194,248 patients met inclusion criteria; 79,813 patients (41%) received SG and 114,435 patients (59%) received RYGB. The use of SG was associated with a significantly lower 30-day hospital readmission rate [adjusted hazard ratios (aHRs) 0.77; 95% confidence interval (CI), 0.74–0.81] and ER visits [aHR, 0.82; 95% CI, 0.80–0.83], and decreased risk of gastrointestinal bleeding [aHR, 0.87; 95% CI, 0.78–0.98] compared to RYGB. However, SG was associated with an increased risk of revisional surgery, compared to RYGB [aHR,1.21; 95% CI, 1.08–1.35].

Conclusions

Among patients receiving bariatric surgery in a real-world setting, SG was associated with lower complication rate but a higher risk of revisional surgery compared to RYGB. Further longitudinal studies are needed to assess long-term findings.

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Authors and Affiliations

  1. Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA

    Abdullah A. Alalwan, Haesuk Park, Richard Segal & Abraham Hartzema

  2. Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Qassim, Saudi Arabia

    Abdullah A. Alalwan

  3. UF Health Bariatric Surgery Center, Department of Surgery, University of Florida, Gainesville, FL, USA

    Jeffrey Friedman

  4. Department of Biostatistics, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA

    Babette Brumback

Authors
  1. Abdullah A. Alalwan
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  2. Jeffrey Friedman
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  3. Haesuk Park
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  4. Richard Segal
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  5. Babette Brumback
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  6. Abraham Hartzema
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Correspondence to Abdullah A. Alalwan.

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Supplementary file1 (DOCX 17 kb)

Appendix 1: Case definitions and related codes

Appendix 1: Case definitions and related codes

See Tables

Table 5 Procedure and obesity codes used to identify bariatric surgery
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Table 6 Diagnosis coding algorithm for Charlson Comorbidity Index and other conditions
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Table 7 List of variables used in propensity score models
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7 and

Table 8 Procedure codes used to identify revisional bariatric surgery
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8.

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Alalwan, A.A., Friedman, J., Park, H. et al. Comparative Safety of Sleeve Gastrectomy and Roux-en-Y: A Propensity Score Analysis. World J Surg 46, 2715–2724 (2022). https://doi.org/10.1007/s00268-022-06664-0

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  • DOI: https://doi.org/10.1007/s00268-022-06664-0

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