Comparison of one anastomosis gastric bypass to standard bariatric interventions: a propensity score matching analysis using the 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database

Background: One-anastomosis gastric bypass (OAGB) has been proposed as a viable alternative to standard bariatric surgical interventions such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Due to one fewer anastomosis, OAGB is perceived to reduce risk and require less operative time compared to RYGB. Objective: We aimed to evaluate the 30-day outcomes of OAGB compared to SG and RYGB. Setting: 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Methods: We analyzed patients who underwent primary SG, RYBG, and OAGB. Using propensity score matching (PSM) analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30-day postoperative outcomes between OAGB versus SG and OAGB versus RYGB. Results: We analyzed 500,477 SG; 190,813 RYGB; and 3607 OAGB. The matched cohorts comparing SG versus OAGB and RYGB versus OAGB had similar preoperative characteristics. PSM outcomes of OAGB versus SG showed OAGB was associated with higher rates of interventions (.9% vs. .4%), reoperations (1.2% vs. .5%), and emergency visits (10.6% vs. 7.4%) (all P < .050). PSM outcomes comparing OAGB versus RYGB showed that OAGB patients had shorter length of stay (1.29 ± .93 vs. 1.49 ± 1.18), as well as lower rates of unplanned intensive care unit admissions (.3% vs .7%), readmissions (2.4% vs. 4.9%), blood transfusions (.2% vs. .8%), interventions (.9% vs 1.5%), nonhome discharge (.1% vs .3%), postoperative bleeding (.2% vs .8%), and intestinal obstruction (.2% vs 1.0%), compared to RYGB (all P < .050). Conclusion: While OAGB is a more complex surgery than SG and requires more emergency visits, reoperations, and interventions, it is a safe and feasible alternative to RYGB, with fewer adverse short-term outcomes than RYGB.