S1005 Prevalence of Dysphagia After Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy: A National Propensity Score Study

Introduction: Bariatric surgery is increasingly performed, with laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) being the most common procedures. The comparative incidence of dysphagia after LSG and RYGB is not well-studied. We aimed to determine the incidence of dysphagia following LSG and RYGB using a large database. Methods: Utilizing the U.S. Collaborative Network within TriNetX, which brings together data from 66 health care organizations from the United States, we conducted a population-based cohort study to examine the incidence of dysphagia after RYGB and LSG versus patients with morbid obesity who did not undergo bariatric surgery from 2014 to 2024. The database uses International Classification of Diseases codes for diagnoses and Current Procedural Terminology codes for procedures. A 1:1 propensity score matching was performed to adjust for obstructive sleep apnea, proton pump inhibitor use, gastroesophageal reflux disease, age, tobacco, and alcohol use. The odds of developing dysphagia within 1 month, 1-3 months, 3-6 months, 6-12 months, 1-3 years, 3-5 years, and 5-10 years after bariatric surgery was also examined. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results: A total of 2,761,563 patients with morbid obesity were included in the analysis. Of these, 2,616,988 did not undergo surgery (No Surgery group), and 223,415 (8.53%) from that group developed dysphagia. Twenty-nine thousand two hundred forty-two underwent RYGB (RYGB group), of whom 4,277 (14.6%) developed dysphagia (RYGB vs No Surgery OR 2.48; 95% CI [2.24- 2.61]; P < 0.01). Fifty-seven thousand thirteen patients underwent LSG (LSG group), of whom 4,820 (8.67%) developed dysphagia (LSG vs No Surgery OR 1.5; 95% CI [1.42-1.62]; P < 0.01). In both surgical groups, the incidence of dysphagia was highest within 30 days after the surgery with 30% of patients in the RYGB developing dysphagia and 24.3% in the LSG developing dysphagia. In a propensity-scored analysis compared to patients with morbid obesity that did not undergo surgery, RYGB (OR 1.57; 95% CI [1.48-1.67]; P < 0.01) and LSG (OR 1.16; 95% CI [1.10-1.12]; P < 0.01) were both independent risk factors for dysphagia. Conclusion: Based on a large national database the incidence of dysphagia is increased after both LSG and RYGB compared to patients with morbid obesity who did not undergo surgery, though the increased incidence is more pronounced after RYGB. Dysphagia mostly occurred within the first 30 days postoperatively in both RYGB and LSG groups. Further studies are needed to determine the etiologies of dysphagia.