Hospital utilization 4 years after bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass

Jul 31, 2019Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Hospital use in the 4 years after sleeve gastrectomy versus Roux-en-Y gastric bypass surgery

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Abstract

Among 3540 sleeve gastrectomy (SG) and 13,587 Roux-en-Y gastric bypass (RYGB) patients, the risk of hospitalizations during the first postoperative year was significantly lower for SG (odds ratio 0.73).

Postoperative yearly hospital length of stay was similar for SG and RYGB across the first four years.
SG patients had lower rates of hospitalizations and emergency department visits in the first year post-surgery.
In the fourth postoperative year, SG patients experienced a higher risk of emergency department visits compared to RYGB patients.
Overall hospital utilization remained low for both SG and RYGB up to four years after surgery.
The early perioperative advantages of SG did not translate to reduced hospital use in the long term compared to RYGB.

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BACKGROUND: While sleeve gastrectomy (SG) has lower perioperative risk compared with Roux-en-Y gastric bypass (RYGB), long-term data about their differential impact on overall health are unclear. Hospital use after bariatric surgery is an important parameter for improving peri- and postoperative care.

OBJECTIVE: This present study was aimed to compare SG and RYGB in terms of their effect on long-term hospital-based healthcare utilization.

SETTING: Multicenter, statewide database.

METHODS: A retrospective cohort study of adult patients who underwent SG and RYGB between 2009 and 2011, with follow-up until 2015 and 2-year presurgery information. Propensity score-matched SG and RYGB groups were created using preoperative demographic characteristics, co-morbidities, and presurgery hospital use, measured by cumulative length of stay (LOS) and frequency of emergency department visits. Postsurgery yearly LOS, incidence of hospital visits, and the reason for the visit were compared. Primary outcomes included postoperative hospital visits during years 1 to 4 after bariatric surgery and cumulative LOS. Secondary outcomes included specific reasons for hospital use.

RESULTS: There were 3540 SG and 13,587 RYGB patients, whose mean (95% confidence interval [CI]) LOS was 1.3 (1.3-1.4), .9 (.8-1), 1 (.9-1.1), and 1.2 (1-1.3) days at years 1 through 4, respectively. Postoperative yearly LOS was similar between the 2 propensity-matched groups. The risk of hospitalizations (odd ratio .73, 95% CI .64-.84, P < .0001) and emergency department visits (odds ratio .84, 95% CI .75-.95, P = .005) was significantly lower for SG, during the first postoperative year. The reverse was seen at the fourth postoperative year, with higher risk of emergency department use after SG (odds ratio 1.16, 95% CI 1.01-1.33, P = .035).

CONCLUSION: Postoperative 4-year hospital utilization remains low for both SG and RYGB. The previously established lower early perioperative risk of SG was not appreciated for longer-term hospital use compared with RYGB.

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Hospital utilization 4 years after bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass

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