Importance Additional data comparing longer-term problems associated with various bariatric surgical procedures are needed for shared decision-making. Objective To compare the risks of intervention, operation, endoscopy, hospitalization, and mortality up to 5 years after 2 bariatric surgical procedures. Design, Setting, and Participants Adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2005, and September 30, 2015, within the National Patient-Centered Clinical Research Network. Data from 33 560 adults at 10 centers within 4 clinical data research networks were included in this cohort study. Information was extracted from electronic health records using a common data model and linked to insurance claims and mortality indices. Analyses were conducted from January 2018 through October 2019. Exposures Bariatric surgical procedures. Main Outcomes and Measures The primary outcome was time until operation or intervention. Secondary outcomes included endoscopy, hospitalization, and mortality rates. Results Of 33 560 adults, 18 056 (54%) underwent RYGB, and 15 504 (46%) underwent SG. The median (interquartile range) follow-up for operation or intervention was 3.4 (1.6-5.0) years for RYGB and 2.2 (0.9-3.6) years for SG. The overall mean (SD) patient age was 45.0 (11.5) years, and the overall mean (SD) patient body mass index was 49.1 (7.9). The cohort was composed predominantly of women (80%) and white individuals (66%), with 26% of Hispanic ethnicity. Operation or intervention was less likely for SG than for RYGB (hazard ratio, 0.72; 95% CI, 0.65-0.79; P < .001). The estimated, adjusted cumulative incidence rates of operation or intervention at 5 years were 8.94% (95% CI, 8.23%-9.65%) for SG and 12.27% (95% CI, 11.49%-13.05%) for RYGB. Hospitalization was less likely for SG than for RYGB (hazard ratio, 0.82; 95% CI, 0.78-0.87; P < .001), and the 5-year adjusted cumulative incidence rates were 32.79% (95% CI, 31.62%-33.94%) for SG and 38.33% (95% CI, 37.17%-39.46%) for RYGB. Endoscopy was less likely for SG than for RYGB (hazard ratio, 0.47; 95% CI, 0.43-0.52; P < .001), and the adjusted cumulative incidence rates at 5 years were 7.80% (95% CI, 7.15%-8.43%) for SG and 15.83% (95% CI, 14.94%-16.71%) for RYGB. There were no differences in all-cause mortality between SG and RYGB. Conclusions and Relevance Interventions, operations, and hospitalizations were relatively common after bariatric surgical procedures and were more often associated with RYGB than SG. Trial Registration ClinicalTrials.gov identifier: NCT02741674.

中文翻译：

---

来自美国国家以患者为中心的临床研究网络减肥研究队列中减肥手术后 5 年的干预和手术。

重要性 需要更多的数据来比较与各种减肥手术相关的长期问题，以便共同决策。目的 比较 2 次减肥手术后 5 年内的干预、手术、内窥镜检查、住院和死亡率风险。设计、设置和参与者 2005 年 1 月 1 日至 2015 年 9 月 30 日期间在国家以患者为中心的临床研究网络内接受 Roux-en-Y 胃旁路术 (RYGB) 或袖状胃切除术 (SG) 的成年人。该队列研究包括来自 4 个临床数据研究网络内 10 个中心的 33 560 名成年人的数据。信息是使用通用数据模型从电子健康记录中提取的，并与保险索赔和死亡率指数相关联。分析于 2018 年 1 月至 2019 年 10 月进行。暴露减肥手术程序。主要结果和措施 主要结果是手术或干预前的时间。次要结果包括内窥镜检查、住院和死亡率。结果 在 33 560 名成人中，18 056 人（54%）接受了 RYGB，15 504 人（46%）接受了 SG。RYGB 手术或干预的中位（四分位距）随访时间为 3.4 (1.6-5.0) 年，SG 为 2.2 (0.9-3.6) 年。总体平均 (SD) 患者年龄为 45.0 (11.5) 岁，总体平均 (SD) 患者体重指数为 49.1 (7.9)。该队列主要由女性 (80%) 和白人 (66%) 组成，西班牙裔占 26%。SG 手术或干预的可能性低于 RYGB（风险比，0.72；95% CI，0.65-0.79；P < .001）。据估计，SG 和 RYGB 的 5 年调整后手术或干预累积发生率分别为 8.94%（95% CI，8.23%-9.65%）和 12.27%（95% CI，11.49%-13.05%）。SG 住院的可能性低于 RYGB（风险比，0.82；95% CI，0.78-0.87；P < .001），5 年调整后累积发病率为 32.79%（95% CI，31.62%-33.94 %) SG 和 38.33% (95% CI, 37.17%-39.46%) RYGB。SG 内镜检查的可能性低于 RYGB（风险比，0.47；95% CI，0.43-0.52；P < .001），5 年调整后累积发生率为 7.80%（95% CI，7.15%-8.43 %) SG 和 15.83% (95% CI, 14.94%-16.71%) RYGB。SG 和 RYGB 之间的全因死亡率没有差异。结论和相关性 干预、操作、和住院在减肥手术后相对常见，并且与 RYGB 的相关性比 SG 更常见。试验注册 ClinicalTrials.gov 标识符：NCT02741674。