Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database

Maher El Chaar, Peter Lundberg, Jill Stoltzfus
Surgery for Obesity and Related Diseases 2018, 14 (5): 545-551

BACKGROUND: According to recent American Society for Metabolic and Bariatric Surgery estimates, sleeve gastrectomy (SG) is now the most commonly performed procedure in the United States (~53.8% of all bariatric procedures), followed by Roux-en-Y gastric bypass (RYGB; 23.1% of all procedures).

OBJECTIVES: The objective of this study was to evaluate outcomes and safety of these 2 procedures in the first 30 days postoperatively using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

SETTING: University health network, United States.

METHODS: We reviewed all SG and RYGB cases entered between January 1 and December 31, 2015 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2 , or Fisher's exact tests as appropriate, with P<.05 denoting statistical significance and no adjustment for multiple testing.

RESULTS: A total of 141,646 patients were analyzed; 98,292 underwent SG and 43,354 underwent RYGB. Average age was 44.5 and 45.4 years for SG and RYGB, respectively. Preoperative body mass index was 45.1 and 46.1 for SG and RYGB, respectively. The 30-day mortality was .1% for SG and .2% for RYGB (P<.05). The incidence of unplanned intensive care unit admission after RYGB was twice as high compared with SG (1.3% versus .6%, respectively, P<.05). The incidence of at least 1 intervention or reoperation after RYGB was significantly higher compared with SG (2.8% and 2.5% for GB versus 1.2% and 1% for SG, P<.05). After RYGB, .4% of patients had a drain left in place at 30 days postoperatively versus .3% for SG (P<.05). The incidence of readmission was 2.8% for RYGB and 1.2% for SG (P<.05).

CONCLUSIONS: The incidence of postoperative complications in the first 30 days after surgery is low for both RYGB and SG. However, SG seems to have a better safety profile in the first 30 days postoperatively compared with RYGB. These findings should be considered in the preoperative evaluation and counseling of bariatric patients. Long-term follow-up is needed to compare safety and efficacy of SG versus RYGB.

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