Sleeve gastrectomy is safer than gastric bypass for Medicare patients after five years, researchers led by University of Michigan Health has reported. Five years after each procedure, patients who underwent a sleeve gastrectomy, had a lower risk of death and complications compared to gastric bypass patients. However, sleeve gastrectomy patients were more likely to need follow-up surgery, which could indicate that gastric bypass is more effective long-term, even though it carries more risks. The findings, ‘Comparative Safety of Sleeve Gastrectomy and Gastric Bypass Up to 5 Years After Surgery in Patients With Severe Obesity’, published in JAMA Surgery.
"It's really important for patients to understand the risk of significant issues like death, complications and hospitalisation after these two procedures because that helps inform the decision about which type of bariatric surgery to choose," said Dr Ryan Howard, a general surgery resident at Michigan Medicine and the first author of the study. "You could envision a scenario where a patient is averse to that risk, and so even if a sleeve gastrectomy doesn't confer as much weight loss, they may want it because it's the safer surgery. On the other hand, if a patient has a lot of comorbidities, and a bypass is going to afford a better clinical benefit, maybe that risk is worth it."
The aim of the study was to compare the safety of sleeve gastrectomy and gastric bypass in a large cohort of commercially insured bariatric surgery patients from the IBM MarketScan claims database (2012 to 2016), while accounting for measurable and unmeasurable sources of selection bias in who is chosen for each operation. The researchers identified re-interventions and complications at 30 days and two years from surgery.
A total of 38,153 patients who underwent bariatric surgery between 2012 and 2016, the share of sleeve gastrectomy rose from 52.6% (2012) to 75% (2016). At two years from surgery, patients undergoing sleeve gastrectomy had fewer re-interventions (sleeve 9.9%, bypass 15.6%, p<0.001) and complications (sleeve 6.6%, bypass 9.6%, p=0.001), and lower overall healthcare spending (US$47,891 vs US$55,213, p=0.003), than patients undergoing gastric bypass. However, at the two-year mark, revisions were slightly more common in sleeve gastrectomy than in gastric bypass (sleeve 0.6%, bypass 0.4%, p=0.009).
The authors concluded that the higher risk of revisions in sleeve gastrectomy patients merits further exploration.