Background

Roux-en Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are effective treatments for diabetes. Choice of procedure should be based on the risk-benefit perspective. Objective: The aim of the study was to assess the safety of Roux-Y gastric bypass compared to sleeve gastrectomy in patients with diabetes.

Methods

Preoperative characteristics and 30-day outcomes from the MBSAQIP data sets 2015-2017 were selected for all patients with diabetes mellitus requiring therapy with non-insulin agents or insulin who underwent primary RYGB or SG. The primary outcome was mortality. Secondary outcomes were: reoperation, readmission, morbidity, leak and bleed rates. Propensity score matching was used to control for potential confounding.

Results

Results: Among 107 045 eligible patients, 39 566 patients who underwent RYGB and 39 566 who underwent SG had similar propensity scores and were included in the analyses. RYGB, as compared with SG, was associated with a similar risks of death (0.02% versus 0.04%, respectively; relative risk [RR], 0.60; 95% confidence interval [CI], 0.26 to 1.37; P=0.221), and higher risk of reoperation (2.40% vs. 1.08%; RR, 2.21; 95%CI, 1.98 to 2.48; P<0.001), readmission (6.99% vs. 3.97%; RR, 1.76; 95% CI, 1.66 to 1.87; P<0.001), leakage (0.81% vs. 0.56%; RR, 1.44; 95% CI, 1.21 to 1.70; P<0.001), bleeding (2.07% vs. 0.91%; RR, 2.28; 95% CI, 2.02 to 2.58; P<0.001).

Conclusions

RYGB in patients with diabetes mellitus requiring therapy with non-insulin agents or insulin was associated with similar risks of death, and a higher risk of reoperation,readmission, leakage, bleeding.