Long-Term Healthcare-Related Costs Eight Years After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Nationwide Register-Based Study

Abstract

Objective: To compare long-term healthcare-related costs and contacts up to eight years after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), and to identify factors associated with increasing postoperative expenditures. Background: Bariatric surgery is a highly effective treatment for severe obesity, but knowledge regarding long-term healthcare utilization after different surgical procedures remains limited. Methods: A nationwide register-based study of patients undergoing RYGB or SG in Denmark between 2008 and 2018, with follow-up until June 2023. Healthcare-related costs (primary healthcare, secondary healthcare, and pharmaceuticals) were analyzed across sectors. Cost trends were discounted and plotted annually. Multivariable logistic regression identified risk factors for increasing healthcare-related costs. Results: A total of 18,090 individuals were included: 16,387 RYGB and 1703 SG. Median follow-up was 13 years for RYGB and six years for SG. Total healthcare-related costs were higher after RYGB during the first three postoperative years, followed by a gradual decline. Costs after SG increased from the third postoperative year onward. In multivariable logistic regression analyses, SG was associated with increasing total healthcare-related costs (odds ratio 1.54, 95% confidence interval 1.38-1.72, p<0.0001) and secondary healthcare costs (odds ratio 1.59, 95% confidence interval 1.42-1.78, p<0.0001). These findings remained consistent in subgroup analyses evaluating weight loss and attrition patterns. Conclusions: RYGB was associated with higher healthcare-related costs during the early postoperative period, whereas SG was associated with increasing costs from the third postoperative year onward. These differing cost trajectories may reflect important long-term differences in healthcare utilization following bariatric surgery.