Abstract 13641: Cardiovascular Safety of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass

Abstract

Introduction: Surgical treatment for obesity, a major risk factor for diabetes and cardiovascular disease, may lead to important improvements in cardiovascular health. Sleeve gastrectomy (SG) procedures have gained popularity over Roux-en-Y gastric bypass (RYGB), though it is unclear which procedure results in better cardiovascular (CV) outcomes. Our objective was to evaluate the comparative cardiovascular effectiveness of SG vs. RYGB for CV outcomes. Methods: Using two commercial claims databases, we identified a cohort of patients >18 years with a BMI ≥40 kg/m 2 , who underwent a SG or RYGB procedure between 2010 and 2023. Patients undergoing a SG were propensity-score (PS) matched 1:1 to RYGB patients, adjusting for >75 baseline covariates. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were computed to assess the risk of a primary composite CV outcome, comprising of atherosclerotic CV events (myocardial infarction, stroke, coronary procedure, and unstable angina) and hospitalization for heart failure (HHF). Secondary outcomes were the individual components of the composite outcome and all-cause mortality. Subjects were followed until the first of occurrence of an outcome, end of patient data or enrollment or death. Results: A total of 30,375 patients undergoing SG were PS-matched to 30,375 patients undergoing RYGB and followed for a median of 1.5 years (IQR: 0.6, 2.8) ( Table 1 ). Mean age was 46 years and 78% were female. Compared to RYGB, patients undergoing SG had a similar risk of the composite atherosclerotic outcome (HR: 1.03; 95% CI: 0.86, 1.23), a lower risk of HHF (HR: 0.78; 95% CI: 0.67, 0.93), and a lower risk of mortality (HR: 0.72; 95% CI: 0.58, 0.89). Conclusions: SG was associated with a similar risk of atherosclerotic cardiovascular outcomes and a lower risk of HHF compared to RYBG. In addition, SG was associated with a lower risk of mortality compared to RYGB.