Annals of surgeryJun 8, 2021

Hospital Use and Costs for Up to 4 Years After Sleeve Gastrectomy or Gastric Bypass Surgery: A National Insurance Data Study

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 5, 2026

Abstract

The matched cohort included 4263 sleeve gastrectomy (SG) and 4520 Roux-en-Y gastric bypass (RYGB) patients.

SG patients had a lower risk of emergency department visits (adjusted hazard ratio of 0.90) and inpatient stays (adjusted hazard ratio of 0.80) compared to RYGB patients.
The reduced risk for SG was particularly evident for complications related to digestive system diagnoses, with adjusted hazard ratios of 0.68 for ED visits and 0.61 for inpatient stays.
In the first year post-surgery, SG patients had lower odds of high acute care costs (adjusted odds ratio of 0.77) compared to RYGB patients.
Cost differences between SG and RYGB diminished by years 3 and 4, with year-4 acute care costs showing an adjusted odds ratio of 1.10.
SG may be associated with fewer complications requiring emergency care and hospitalization, particularly for digestive-related issues.

Simplified

OBJECTIVE: To compare acute care utilization and costs following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

SUMMARY BACKGROUND DATA: Comparing postbariatric emergency department (ED) and inpatient care use patterns could assist with procedure choice and provide insights about complication risk.

METHODS: We used a national insurance claims database to identify adults undergoing SG and RYGB between 2008 and 2016. Patients were matched on age, sex, calendar-time, diabetes, and baseline acute care use. We used adjusted Cox proportional hazards to compare acute care utilization and 2-part logistic regression models to compare annual associated costs (odds of any cost, and odds of high costs, defined as ≥80th percentile), between SG and RYGB, overall and within several clinical categories.

RESULTS: The matched cohort included 4263 SG and 4520 RYGB patients. Up to 4 years after surgery, SG patients had slightly lower risk of ED visits [adjusted hazard ratio (aHR): 0.90; 95% confidence interval (CI): 0.85,0.96] and inpatient stays (aHR: 0.80; 95% CI: 0.73,0.88), especially for events associated with digestive-system diagnoses (ED aHR: 0.68; 95% CI: 0.62,0.75; inpatient aHR: 0.61; 95% CI: 0.53,0.72). SG patients also had lower odds of high ED and high total acute costs (eg, year-1 acute costs adjusted odds ratio (aOR) 0.77; 95% CI: 0.66,0.90) in early follow-up. However, observed cost differences decreased by years 3 and 4 (eg, year-4 acute care costs aOR 1.10; 95% CI: 0.92,1.31).

CONCLUSIONS: SG may have fewer complications requiring emergency care and hospitalization, especially as related to digestive system disease. However, any acute care cost advantages of SG may wane over time.

Key numbers

0.90

Decrease in ED Visits Risk

Adjusted hazard ratio comparing SG vs. RYGB patients.

0.80

Decrease in Hospitalization Risk

Adjusted hazard ratio for hospitalizations after SG vs. RYGB.

0.77

Lower Odds of High Acute Care Costs (Year 1)

Adjusted odds ratio for high acute care costs in SG vs. RYGB patients.

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Hospital Use and Costs for Up to 4 Years After Sleeve Gastrectomy or Gastric Bypass Surgery: A National Insurance Data Study

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