Acute-Care Cost Advantages With Sleeve Gastrectomy Wane With Time

By Reuters Staff

July 06, 2021

NEW YORK (Reuters Health) - Obese patients who choose sleeve gastrectomy (SG) may have fewer complications requiring emergency care and hospitalization than peers who choose Roux-en-Y gastric bypass (RYBG). However, any acute-care cost advantages of SG may wane over time, according to a new study.

SG and RYBG make up the vast majority of bariatric procedures performed in the United States, Dr. Kristina Lewis of Wake Forest University Health Sciences, in Winston-Salem, North Carolina, and colleagues note in Annals of Surgery.

"Comparing post-bariatric emergency department (ED) and inpatient care use patterns could assist with procedure choice and provide insights about complication risk," they say.

Several studies have found increased emergency department (ED) and inpatient stays after both surgeries, potentially more so for patients undergoing RYBG. However, follow-up in many of these studies was limited to the first 30 days after surgery and many did not directly compared SG and RYBG patients, they point out.

They compared acute-care utilization and costs up to four years following sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYBG). They were able to match 4,263 patients who underwent SG with 4520 who had RYBG based on age, gender, diabetes and baseline acute-care use.

Up to four years after the surgery, patients who had SG had slightly lower risk of ED visits (adjusted hazard ratio, 0.90; 95% confidence interval, 0.85 to 0.96) and inpatient stays (aHR: 0.80; 95% CI: 0.73 to 0.88), especially for problems associated with the digestive system.

SG also had a cost advantage compared to RYBG, but only in the first one to two years after surgery. The cost differences decreased by years three and four after surgery (for instance, fourth-year acute-care costs adjusted odds ratio, 1.10; 95% CI, 0.92 to 1.31).

The authors say several caveats are worth noting.

"Though SG patients were slightly less likely to have ED visits and hospitalizations, such episodes were very common after both operations, and appeared to be often related to potentially-preventable side effects of surgery," they report.

The fact that between-surgery differences in acute care use waned over follow-up "could indicate that relative safety benefits of SG are short-lived when balanced against potential greater long-term effectiveness of RYBG," they write.

Overall, they say while their observations "align well with prior research positioning SG as a lower-morbidity procedure, it will be important to understand the durability of these differences, which appeared to wane over time. Clinical changes such as greater weight regain or diabetes relapse after SG may portend better long- term outcomes for RYGB than are reflected here," they caution.

SOURCE: Annals of Surgery, online June 7, 2021.