While clinical outcomes tend to favor Roux-en-Y gastric bypass (RYGB) over sleeve gastrectomy (SG), RYGB is often associated with more post-operativecomplications and may necessitate more frequent healthcare visits for their evaluation, diagnosis, and treatment. To explore this issue, we examined healthcare service utilization related to primary SG vs. RYGB in the first 30 days following surgery at a single MBSAQIP accredited surgical weight loss program.
This was a retrospective chart review of 149 and 313 patients who underwent RYGB and SG, respectively, as an initial surgical weight loss procedure between January 1, 2014 and March 31, 2015. We compared the groups for a number of pre-operative characteristics and the following bariatric-related outcomes within 30 days following surgery: 1) hospital length of stay (LOS); 2) number of hospital readmissions; 3) number of unplanned re-operations. The chi square test and Fisher’s Exact test were used to detect group differences in proportions; t tests (if normally distributed) and Wilcoxon Ranked Sum test were used for continuous variables.
Pre-operative characteristics: Compared to patients who underwent SG, patients who underwent RYGB had higher BMI (46.8 vs. 44.2, p<0.002), and a greater proportion of insulin users (16.2% vs. 8.9%, p<0.034). RYGB patients had higher prevalence of GERD (40% vs. 27%, p<0.005) and and a higher (but not significant) proportion of RYGB patients (74% with score >3 in RYGB vs. 65% in SG, p<0.12). Mean surgical duration (min.) was nearly doubled in RYGB (121 ± 35 vs. 66 ± 21, p<1e-67). The total weight lost at 1 year expressed as a proportion of pre-surgery weight (%TWL), did not differ in RYGB (n=92), 26.9 ± 12.7, vs. SG (n=203), 28.0 ± 13.2 (p=0.49, NS). Healthcare utilization: Hospital length of stay in days did not differ between groups (2.07 ± 0.6, RYGB, vs. 2.16 ± 0.7, SG, excluding one outlier of 57 days for RYGB). Hospital readmissions occurred in 6/149 RYGB patients (4.0%) and 9/313 SG patients (2.9%, p=0.58, NS). The re-operation rate was 3/149 (2.0%) for RYGB and 1/313 (0.3%) for SG (NS, p<0.12). There were no unplanned re-operations.
In this preliminary report, we noted no difference in 30-day healthcare utilization expressed as LOS, re-admissions and re-operations by patients who had RYGB vs. SG. We are in the process of extending the analysis to 1 year after surgery.