OBJECTIVE Bariatric surgery prolongs life expectancy in severely obese individuals, but it is uncertain which of the two dominating bariatric procedures, sleeve gastrectomy or gastric bypass, offers the best long-term survival. RESEARCH DESIGN AND METHODS This was a population-based cohort study of primary laparoscopic sleeve gastrectomy compared with gastric bypass for obesity in Sweden and Finland between 1 January 2007 and 31 December 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs adjusted for age, sex, hypertension, diabetes, Charlson comorbidity index, country, and calendar year. RESULTS Among 61,503 patients (median age 42 years; 75.4% women), who contributed 415,712 person-years at risk (mean 6.8 person-years), 1,571 (2.6%) died during follow-up. Compared with patients who underwent gastric bypass (n = 51,891 [84.4%]), the sleeve gastrectomy group (n = 9,612 [15.6%]) had similar all-cause mortality during the entire study period (HR 0.98, 95% CI 0.81–1.20), but decreased all-cause mortality in more recent years (HR 0.72, 95% CI 0.54–0.97, from 2014 onward). Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than after gastric bypass (HR 1.54, 95% CI 1.06–2.24). CONCLUSIONS The overall survival following sleeve gastrectomy seems to compare well with gastric bypass and may even be better during recent years. A tailored surgical approach in relation to patients’ diabetes status may optimize survival in patients selected for bariatric surgery (i.e., sleeve gastrectomy for patients without diabetes and gastric bypass for patients with diabetes).

中文翻译：

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一项双边队列研究中袖状胃切除术与胃旁路术后的长期生存率

目标 减肥手术可延长严重肥胖个体的预期寿命，但尚不确定两种主要的减肥手术，袖状胃切除术或胃旁路手术，哪一种能提供最佳的长期生存率。研究设提供具有 95% CI 的风险比 (HRs)，其针对年龄、性别、高血压、糖尿病、Charlson 合并症指数、国家和日历年进行了调整。结果 在 61,503 名患者（中位年龄 42 岁；75.4% 为女性）中，有 415,712 人年的风险（平均 6.8 人年），1,571 人（2.6%）在随访期间死亡。与接受胃旁路术的患者（n = 51,891 [84.4%]）相比，袖状胃切除术组（n = 9,612 [15.6%]）在整个研究期间的全因死亡率相似（HR 0.98, 95% CI 0.81– 1.20），但近年来全因死亡率有所下降（HR 0.72，95% CI 0.54–0.97，从 2014 年开始）。糖尿病与减肥手术的类型有显着的相互作用，袖状胃切除术后的全因死亡率高于胃旁路术后（HR 1.54, 95% CI 1.06-2.24）。结论 袖状胃切除术后的总生存率似乎与胃旁路术相媲美，近年来甚至可能更好。根据患者的糖尿病状况量身定制的手术方法可以优化选择进行减肥手术的患者的生存率（即，