Sleeve gastrectomy or gastric bypass: a „post-code” lottery? A comprehensive national analysis of the utilization of bariatric surgery in Switzerland between 2011-2017

Abstract Introduction Sleeve gastrectomy (SG) recently became the most frequently performed bariatric surgery (BS) worldwide, overtaking the long-time standard Roux-en-Y gastric bypass (RYGB). Main indications for one or the other procedure show large inter-center variations and warrant further investigations. The aim of this study was to identify the influencers of primary BS selection in Switzerland. Methods Retrospective analysis of all hospitalizations in Switzerland between 01/01/2011-12/31/2017 with anonymized data provided by the Swiss Federal Statistical Office. BS procedures were identified based on ICD-10 and national surgical codes. Statistical analyses were performed with R. Results 27'375 BS were performed during the study period. The annual BS caseload doubled over time, whereas inpatient complications decreased (∼-33%). RYGB was the prevailing procedure, although its annual proportion decreased from 80% to 70% over 7-years. Meanwhile, use of SG increased from 14 to 23%. Primary RYGB and SG had similar rates of inpatient mortality (∼0.05%) and morbidity (8.0 vs. 7.4%, P=0.148), with the exception of higher ileus rates following RYGB (0.7 vs. 0.1%, P Conclusion Geographic differences in primary BS procedure selection indicate a lack of objective rationales. Long-term risk-benefit and cost-effectiveness analyses are needed to assist evidence-based decision making.