Higher risk of mortality with sleeve gastrectomy compared to gastric bypass in adults with diabetes

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August 22, 2022

2 minute read


Source/Disclosures


Disclosures: The authors report no relevant financial information.


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According to a study published in Diabetic treatments.

In adults without diabetes, the risks were similar with both procedures.



Dag Holmberg, MD, Ph.D.
Holmberg is a research specialist in the Department of Molecular Medicine and Surgery at Karolinska Institutet in Stockholm, Sweden.

“We are now moving towards more individualized medicine, and the results of this study may help patients and physicians choose the most appropriate method of bariatric surgery for each patient,” Dag Holmberg, MD, Ph.D., research specialist at the Department of Molecular Medicine and Surgery at Karolinska Institutet in Stockholm, Sweden, Healio told Healio. “Both methods are effective in maximizing life expectancy, but it appears that preoperative diabetic status is an important variable to consider before embarking on surgery.”

Holmberg and colleagues conducted a population-based cohort study of 61,503 adults who underwent sleeve gastrectomy or gastric bypass surgery for obesity between January 1, 2007 and December 31, 2019 in Sweden and between January 1, 2007 and December 31st. 2018, in Finland (median age, 42 years; 75.4% women). The data was collected from the Nordic Obesity Surgery Cohort, which contains data from national patient, medication and cause of death registries. Adults were defined as diabetic if they received antihyperglycemic medication within one year of surgery. The researchers compared all-cause, cardiovascular disease-specific, and cancer-specific mortality risks between adults who underwent sleeve gastrectomy and those who underwent gastric bypass surgery.

Of the study cohort, 84.4% underwent gastric bypass surgery and 15.6% underwent sleeve gastrectomy. There were 1,571 deaths during an average follow-up of 6.8 years per person. The all-cause mortality rate within 90 days of surgery was 0.04% with sleeve gastrectomy and 0.06% with gastric bypass surgery.

There was no difference in the risk of all-cause mortality between the sleeve gastrectomy and gastric bypass groups. Among adults with diabetes, those who underwent sleeve gastrectomy had a higher risk of all-cause mortality than those who underwent gastric bypass surgery (HR=1.54; 95% CI, 1.06-2.24) . Adults who underwent sleeve gastrectomy from 2014 had a lower risk of all-cause mortality compared to those who underwent gastric bypass surgery (HR=0.72; 95% CI, 0.54-0, 97).

“Sleeve gastrectomy is a relatively new method and was rarely performed before 2010 in Sweden and Finland,” Holmberg said. “We speculate that standardization of surgery and postoperative care may have led to improved survival in recent years, but the study provides no definitive explanation for this finding.”

Cardiovascular disease and cancer were the two leading causes of death during the follow-up period. There was no difference in CV-specific mortality or cancer-specific mortality between the sleeve gastrectomy and gastric bypass groups.

Holmberg said more studies with a longer follow-up period would provide more clarity on whether obese people should have sleeve gastrectomy or gastric bypass surgery.

“Other important outcomes, such as long-term quality of life and resolution of comorbidities, are being addressed in large-scale randomized clinical trials,” Holmberg said.

For more information:

Dag Holmberg, MD, Ph.D.reachable at [email protected].

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