title: Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy is gaining popularity in the United States. However, few studies have examined outcomes of sleeve gastrectomy compared with those of the "gold standard" bariatric operation: Roux-en-Y gastric bypass.
  
  
  METHODS
  Using the American College of Surgeons National Surgical Quality Improvement Program database, clinical data were obtained for all patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass between 2010 and 2011. Main outcomes measures were risk-adjusted 30-day serious morbidity and mortality.
  
  
  RESULTS
  We analyzed 24,117 patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass for the treatment of morbid obesity. Gastric bypass comprised 79.5% of cases and sleeve gastrectomy comprised 20.5%; the proportion of sleeve gastrectomy cases increased from 14.6% in 2010 to 25.8% in 2011. On univariate analysis, sleeve gastrectomy had a shorter mean operative time (101 vs 133 minutes, p < 0.01), a lower rate of blood loss requiring transfusion (0.6% vs 1.5%, p < 0.01), a lower rate of deep wound infections (0.06% vs 0.20%, p = 0.05), lower serious morbidity rate (3.8% vs 5.8%, p < 0.01), and 30-day reoperation rate (1.6% vs 2.5%, p < 0.01), but a higher rate of deep venous thrombosis (0.47% vs 0.21%, p < 0.01). Compared with sleeve gastrectomy, gastric bypass patients had higher risk-adjusted 30-day serious morbidity (odds ratio [OR] 1.32; 95% CI1.11 to 1.56, p < 0.01). Patients who were older, had higher BMI, smoked, or had hypertension were at significantly greater risk of serious morbidity. The 30-day mortality was similar between groups (0.10% for sleeve vs 0.15% for bypass).
  
  
  CONCLUSIONS
  Use of laparoscopic sleeve gastrectomy is increasing on a national level. Compared with laparoscopic gastric bypass, laparoscopic sleeve gastrectomy is associated with lower 30-day risk-adjusted serious morbidity and equivalent 30-day mortality.
authors.affiliation: Department of Surgery, University of California, Irvine, Irvine, CA.
authors.forename: Monica T
authors.initials: MT
authors.lastname: Young
authors.affiliation: Department of Surgery, University of California, Irvine, Irvine, CA.
authors.forename: Alana
authors.initials: A
authors.lastname: Gebhart
authors.affiliation: Department of Statistics, University of California, Irvine, Irvine, CA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Phelan
authors.affiliation: Department of Surgery, University of California, Irvine, Irvine, CA. Electronic address: ninhn@uci.edu.
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D015390:Gastric Bypass / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States