Perioperative risk ‘should be of limited focus’ in choice of bariatric surgical procedure
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Key takeaways:
- Thirty-day readmission rates and incidence of adverse events were low and similar between sleeve gastrectomy and Roux-en-Y gastric bypass groups.
- Operating time was shorter in the sleeve gastrectomy group.
Researchers reported low perioperative risk for complications among patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass, with no clinically significant difference between groups, according to a study in JAMA Network Open.
“Metabolic and bariatric surgery is a well-documented treatment of severe obesity, leading to superior long-term weight loss, improvement or resolution of obesity-related morbidity and reduced mortality compared with nonsurgical management,” Suzanne Hedberg, MD, PhD, of the department of surgery at the University of Gothenburg, and colleagues wrote. “Approximately 600,000 primary surgical bariatric procedures were performed worldwide in 2018, with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) the most prevalent.”
They continued: “The comparative efficacy and safety of SG vs. RYGB remain unclear.”
In a registry-based, multicenter randomized clinical trial, Hedberg and colleagues evaluated data from 1,735 adults with obesity (mean age, 42.9 years; 73.9% women; mean BMI, 40.8) who underwent either SG (n = 878) or RYGB (n = 857) from October 2015 to March 2022. Studied outcomes included perioperative complications at 30 days as well as mortality at 30 and 90 days after surgery.
According to results, the mean operating time was 47.3 minutes in the SG group vs. 67.7 minutes in the RYGB group, with a median postoperative hospital stay of 1 day in both groups. At 30 days, readmission rates were 3.1% and 4%, respectively, and the incidence of any adverse event was 4.6% and 6.3% (OR = 0.71; 95% CI, 0.47-1.08; absolute risk difference = –1.7 percentage points; 95% CI, –3.9 to 0.4).
Serious adverse events occurred among 1.7% of patients in the SG group vs. 2.7% in the RYGB group (OR = 0.63; 95% CI, 0.33-1.22), with an absolute risk difference of –1 percentage points (95% CI, –2.4 to 0.4). Researchers reported no 30- or 90-day mortality.
“We conclude that among adult patients in Sweden and Norway with a BMI of 35 to 50 who underwent SG and RYGB in a large randomized clinical trial, the perioperative morbidity was low and not significantly different between the groups,” Hedberg and colleagues wrote. “We therefore suggest that the perioperative risk should be of limited focus in the choice between SG or RYGB.”
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