Early 60-Day Morbidity after Sleeve Gastrectomy Versus One-Anastomosis Gastric Bypass: A Propensity-Matched Single-Center Cohort of 2,382 Patients

BACKGROUND: Comparative data on early complications after sleeve gastrectomy (SG) versus one-anastomosis gastric bypass (OAGB) remain limited. OBJECTIVE: To compare 60-day postoperative morbidity between SG and OAGB while accounting for confounding. SETTING: Soroka University Medical Center, Israel. METHODS: This is a retrospective cohort study assessing 60-day morbidity in patients undergoing SG and OAGB between 2009 and 2024. Propensity scores (sex, height, BMI, number of previous bariatric surgeries, smoking status, diabetes mellitus, fatty liver, hiatal hernia, cholecystectomy during index surgery, and band removal during index surgery) were used for 1:1 nearest-neighbor matching without replacement. Any potential postoperative events were flagged by utilization triggers (length of stay > 7 days, ICU admission, blood transfusion, CT or upper endoscopy within 60 days) and verified by chart review. The primary outcome of this study was any complication occurring ≤ 60 days from the operation; secondary outcomes included complication types and severity by Clavien-Dindo classification. RESULTS: Of 3,317 patients (SG n = 1,816; OAGB n = 1,501), 1,191 matched pairs were analyzed. Overall, 60-day complications were higher after SG than OAGB (15.4% vs. 11.8%, p = 0.012). SG patients exhibited more Clavien-Dindo grade II (5.1% vs. 2.4%, p > 0.001), IIIa events (1.3% vs. 0.3%, p = 0.003) and IVb events (0.7% vs. 0.1%, p = 0.039). SG patients experienced higher rates of leak (1.8% vs. 0.8%, p = 0.019), abscess (1.2% vs. 0%, p < 0.001), pleural and abdominal fluid collection (1.2% vs. 0.3%, p = 0.007), bleeding (1.6% vs. 0.7%, p = 0.033) and dysphagia/vomiting (3.2% vs. 1.3%, p = 0.001) compared with OAGB patients. OAGB patients presented with more endoscopically diagnosed ulcers (0.7% vs. 0%, p = 0.008) and respiratory complaints (2.2% vs. 0.6%, p < 0.001) compared to SG patients. Among complicated patients, upper endoscopy within 60 days was more frequent after SG (29.3% vs. 17.3%, p = 0.005); ICU length of stay was not different between the groups (0.8 ± 5.4 days in OAGB vs. 1.2 ± 9.1 days in SG, p = 0.5). CONCLUSIONS: In a large propensity-matched single-center cohort study, SG showed higher 60-day morbidity than OAGB, primarily of intermediate severity. Limitations include retrospective design, temporal bias, trigger-based ascertainment, and lack of capture of care delivered at external hospitals.