Sleeve Gastrectomy Has Lower 5-Year Mortality, Complication, and Reintervention Risk Than Gastric Bypass

sleeve gastrectomy
sleeve gastrectomy
Investigators assessed long-term outcomes of sleeve gastrectomy vs gastric bypass in patients undergoing bariatric surgery.

For patients undergoing bariatric surgery, risk for long-term mortality, complications, and reintervention was lower among sleeve gastrectomy recipients, according to results of a retrospective cohort study, published in JAMA Surgery.

Data were sourced from Medicare fee-for-service claims filed between 2012 and 2018. Patients who received a gastric bypass (n=38,402) or sleeve gastrectomy (n=57,003) were assessed for 5-year outcomes.

The bypass and gastrectomy cohorts were aged mean 55.9 (SD, 11.7) years and 57.1 (SD, 11.8) years, 75.7% and 74.2% were women, 78.1% and 75.8% were White, 76.9% and 75.9% had hypertension, and 44.5% and 36.4% had diabetes, respectively.

At 5 years, sleeve gastrectomy was associated with decreased risk for mortality (adjusted hazard ratio [aHR], 0.84; 95% CI, 0.74-0.95), complications (aHR, 0.73; 95% CI, 0.67-0.80), and reintervention (aHR, 0.77; 95% CI, 0.71-0.85).

Among reinterventions at year 5, sleeve gastrectomy was associated with decreased enteral access procedures (aHR, 0.62; 95% CI, 0.48-0.80) and reoperations (aHR, 0.66; 95% CI, 0.59-0.73) but more revisions (aHR, 3.41; 95% CI, 2.44-4.74). Among reoperations, sleeve gastrectomy had fewer internal hernia (aHR, 0.05; 95% CI, 0.02-0.09) and biliary (aHR, 0.52; 95% CI, 0.45-0.60) but more paraesophageal hernia (aHR, 3.16; 95% CI, 2.16-4.63) procedures.

At 1 year, sleeve gastrectomy was associated with decreased health care costs ($28,706 vs $30,663; P <.05) but the differences were no longer significant at 3 ($57,411 vs $58,581) or 5 ($86,584 vs $85,762) years.

Researchers noted adverse event and complication incidence rates were higher in this study than have previously been reported. This may be due to the source population (Medicare fee-for-service).

This study found that gastric bypass was associated with increased risk for 5-year mortality (5.67% vs 4.27%), complications (29.03% vs 22.10%), and reinterventions (33.57% vs 25.23%) compared with sleeve gastrectomy. However, patients who underwent a gastric bypass were less likely to require surgical revision.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Howard R, Chao GF, Yang J, et al. Comparative safety of sleeve gastrectomy and gastric bypass up to 5 years after surgery in patients with severe obesity. JAMA Surg. Published online October 6, 2021. doi:10.1001/jamasurg.2021.4981