Mortality risk higher with sleeve gastrectomy vs. gastric bypass for adults with diabetes
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Adults in Finland and Sweden with diabetes who underwent sleeve gastrectomy were more likely to die from any cause compared with those who underwent gastric bypass, according to a study published in Diabetes Care.
Among adults without diabetes, risks were similar with the two procedures.
“We are now moving toward more individualized medicine, and the findings from this study may help patients and physicians choose the most appropriate method of bariatric surgery for the individual patient,” Dag Holmberg, MD, PhD, research specialist in the department of molecular medicine and surgery at Karolinska Institutet in Stockholm, Sweden, told Healio. “Both methods are effective for the purpose of maximizing life expectancy, but it does seem like preoperative diabetes status is an important variable to consider before embarking on surgery.”
Holmberg and colleagues conducted a population-based cohort study of 61,503 adults who underwent sleeve gastrectomy or gastric bypass for obesity between Jan. 1, 2007, and Dec. 31, 2019, in Sweden and between Jan. 1, 2007, and Dec 31, 2018, in Finland (median age, 42 years; 75.4% women). Data were collected from the Nordic Obesity Surgery Cohort, which contains data from national patient, drug and cause of death registries. Adults were defined as having diabetes if they were prescribed an antihyperglycemic drug within 1 year of surgery. Researchers compared all-cause, cardiovascular-specific and cancer-specific mortality risks between adults who had a sleeve gastrectomy and those who underwent gastric bypass.
Of the study cohort, 84.4% underwent gastric bypass and 15.6% underwent sleeve gastrectomy. There were 1,571 deaths during a mean follow-up of 6.8 years per person. The all-cause mortality rate within 90 days of surgery was 0.04% with sleeve gastrectomy and 0.06% with gastric bypass.
There was no difference in all-cause mortality risk between the sleeve gastrectomy and gastric bypass groups. Among adults with diabetes, those who underwent sleeve gastrectomy had a higher risk for all-cause mortality than those who underwent gastric bypass (HR = 1.54; 95% CI, 1.06-2.24). Adults who underwent sleeve gastrectomy from 2014 onward had a lower risk for all-cause mortality compared with those who had gastric bypass (HR = 0.72; 95% CI, 0.54-0.97).
“Sleeve gastrectomy is a relatively novel method and was rarely performed before 2010 in Sweden and Finland,” Holmberg said. “We speculate that the standardization of the surgery and postoperative care may have led to improved survival in more recent years, but the study does not provide any definitive explanation for this finding.”
CVD and cancer were the two most common causes of death during the follow-up period. There was no difference in CV-specific mortality or cancer-specific mortality between the sleeve gastrectomy and gastric bypass groups.
Holmberg said more studies with a longer follow-up period will provide more clarity on whether people with obesity should undergo either sleeve gastrectomy or gastric bypass.
“Other important outcomes, such as long-term quality of life and resolution of comorbidities, are being addressed in large scale randomized clinical trials,” Holmberg said.
For more information:
Dag Holmberg, MD, PhD, can be reached at dag.holmberg@ki.se.
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