Comparative safety profile of metabolic and bariatric surgery procedures: an analysis spanning twelve years.

Background

Laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LRYGB) are the most commonly performed metabolic and bariatric surgery (MBS) procedures, while laparoscopic biliopancreatic diversion with duodenal switch (LBPD/DS) remains a less common alternative. We used pairwise propensity score matching (PSM) to compare the short-term outcomes of the 3 procedures.

Objectives

This study aimed to compare early postoperative outcomes among patients undergoing LSG, LRYGB, and LBPD/DS. Primary outcomes included 30-day all-cause mortality, serious morbidity, and overall morbidity. Secondary outcomes included readmission, unplanned reoperation, length of hospital stay, and operative time.

Setting

A national, multicenter study of patients who underwent MBS at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).

Methods

Cases of LSG, LRYGB, and LBPD/DS performed between 2005 and 2017 were identified from the ACS-NSQIP database. Pairwise PSM and logistic regression analysis were performed to compare postoperative outcomes within 30 days of surgery.

Results

Of the 188,012 patients identified, 6324 were matched (2108 in each group). Compared to LRYGB, LSG was associated with lower odds of serious morbidity (odds ratio [OR] .61, P = .016), reoperation (OR .31, P < .001), and readmission (OR .39, P < .001). In contrast, LBPD/DS was associated with higher odds of serious morbidity (OR 1.76, P < .001), minor morbidity (OR 1.65, P < .001), and readmission (OR 1.37, P = .039).

Conclusions

Despite adjusting for baseline characteristics, LBPD/DS remained associated with the highest odds of 30-day complications, whereas LSG demonstrated the most favorable safety profile. Careful patient selection and thorough preoperative optimization are essential for achieving optimal outcomes in patients undergoing MBS.