Long-term survival after sleeve gastrectomy versus gastric bypass in a bi-national cohort study

Abstract

<p> </p> <p><strong>Objective:</strong> Bariatric surgery prolongs life expectancy in severely obese individuals, but it is uncertain which of the two dominating bariatric procedures, sleeve gastrectomy or gastric bypass, offers the best long-term survival.</p> <p><strong>Research Design and Methods:</strong> This was a population-based cohort study comparing primary laparoscopic sleeve gastrectomy to gastric bypass for obesity in Sweden and Finland between January 1, 2007 and December 31, 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, hypertension, diabetes, Charlson comorbidity index, country, and calendar year.</p> <p><strong>Results: </strong>Among 61,503 patients (median age 42 years; 75.4% women), who contributed 415,712 person-years at risk (mean 6.8 person-years), 1,571 (2.6%) died during follow-up. Compared to patients who underwent gastric bypass (n=51,891, 84.4%), the sleeve gastrectomy group (n=9,612, 15.6%) had similar all-cause mortality during the entire study period (HR=0.98, 95% CI 0.81-1.20), but decreased all-cause mortality in more recent years (HR=0.72, 95% CI 0.54-0.97, from 2014 onwards). Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than gastric bypass (HR=1.54, 95% CI 1.06-2.24). </p> <p><strong>Conclusions: </strong>The overall survival following sleeve gastrectomy seems to compare well with gastric bypass, and may even be better during recent years. A tailored surgical approach in relation to patients’ diabetes status may optimize survival in patients selected for bariatric surgery, i.e. sleeve gastrectomy for non-diabetic patients and gastric bypass for patients with diabetes. </p>