Comparative safety profile of metabolic and bariatric surgery procedures: an analysis spanning twelve years.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LRYGB) are the most commonly performed metabolic and bariatric surgery (MBS) procedures, while laparoscopic biliopancreatic diversion with duodenal switch (LBPD/DS) remains a less common alternative. We used pairwise propensity score matching (PSM) to compare the short-term outcomes of the 3 procedures. OBJECTIVES: This study aimed to compare early postoperative outcomes among patients undergoing LSG, LRYGB, and LBPD/DS. Primary outcomes included 30-day all-cause mortality, serious morbidity, and overall morbidity. Secondary outcomes included readmission, unplanned reoperation, length of hospital stay, and operative time. SETTING: A national, multicenter study of patients who underwent MBS at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). METHODS: Cases of LSG, LRYGB, and LBPD/DS performed between 2005 and 2017 were identified from the ACS-NSQIP database. Pairwise PSM and logistic regression analysis were performed to compare postoperative outcomes within 30 days of surgery. RESULTS: Of the 188,012 patients identified, 6324 were matched (2108 in each group). Compared to LRYGB, LSG was associated with lower odds of serious morbidity (odds ratio [OR] .61, P = .016), reoperation (OR .31, P < .001), and readmission (OR .39, P < .001). In contrast, LBPD/DS was associated with higher odds of serious morbidity (OR 1.76, P < .001), minor morbidity (OR 1.65, P < .001), and readmission (OR 1.37, P = .039). CONCLUSIONS: Despite adjusting for baseline characteristics, LBPD/DS remained associated with the highest odds of 30-day complications, whereas LSG demonstrated the most favorable safety profile. Careful patient selection and thorough preoperative optimization are essential for achieving optimal outcomes in patients undergoing MBS.