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For patients receiving metabolic bariatric surgery, those who underwent gastric bypass had lower rates of major adverse cardiovascular events (MACE) than those who had sleeve gastrectomy, according to findings published in JAMA Surgery.

These findings were observed during a follow-up period of up to 11 years.

The study aimed to evaluate MACE risk for patients undergoing gastric bypass versus sleeve gastrectomy using administrative claims data from patients undergoing either procedure for obesity between January 2012 and December 2022. A weighted cohort was assessed to determine the primary outcome of four-point MACE, including acute myocardial infarction, ischemic stroke, heart failure hospitalizations, and all-cause mortality. Secondary outcomes included the individual components of MACE, surgical reinterventions, and related complications.

Benefits of Gastric Bypass Versus Sleeve Gastrectomy

The study included 39,067 patients in the main analysis, most of whom (77.5%) underwent gastric bypass, while far fewer (22.5%) underwent sleeve gastrectomy. Median patient age was 42 years, and most (73.1%) were women. More than half of the study population (60.7%) had a BMI of 40 or higher.

After weighting, and during a median follow-up of 5.1 years, the primary outcome was reported in 577 patients in the gastric bypass group (1.9%) and 264 patients in the sleeve gastrectomy group (3.0%), with incidence rates of 3.96 and 5.10 per 1000 patient-years, respectively (hazard ratio [HR], 0.75; 95% CI, 0.64-0.88). This difference was primarily driven by lower rates of acute myocardial infarction (HR, 0.63; 95% CI, 0.46-0.86), the researchers noted. They observed no differences in ischemic stroke, hospitalization for heart failure, and all-cause mortality.

Both short- and long-term secondary outcomes favored gastric bypass over sleeve gastrectomy, except for higher rates of revision surgery and immediate postoperative complications.

Also, after weighting, patients who had gastric bypass experienced a lower risk for conversion surgery (HR, 0.13; 95% CI, 0.11-0.14) as well as GERD or peptic ulcer disease (HR, 0.71; 95% CI, 0.65-0.77). However, these patients had an almost four-fold higher risk for reoperation for revision of the initial surgery (HR, 3.63; 95% CI, 3.14-4.19) and were more likely to be hospitalized for psychiatric disorders (HR, 1.12; 95% CI, 1.00-1.24).

Role of Shared Decision Making in Weight Loss Surgery

 Study investigators reported no differences between groups in terms of rates of ischemic stroke, hospitalization for heart failure, and all-cause mortality.

The findings indicate that gastric bypass is associated with a reduced incidence of MACE compared with sleeve gastrectomy, according to the researchers, who also noted that both procedures are beneficial for weight loss and better cardiovascular outcomes, but gastric bypass may be associated with higher cardiovascular benefits.

Furthermore, they emphasized that these findings “must be balanced against the higher risk of postoperative complications and the need for surgical revisions associated with gastric bypass,” underscoring the importance of tailored patient selection and shared decision-making in clinical settings.