Beyond initial weight loss: procedure-specific predictors of weight recurrence after metabolic and bariatric surgery

Weight recurrence (WR) after metabolic and bariatric surgery (MBS) remains a significant long-term challenge, yet the preoperative factors that predispose patients to WR may differ across procedures. This study aimed to compare preoperative predictors of WR following sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS).

This is a retrospective review of patients undergoing primary SG, RYGB, or DS between 2008 and 2022, with at least 36 months follow-up and achievement of an optimal clinical response ≥ 20% of total weight loss (TWL). Baseline demographic and clinical variables were collected including age, sex, race, preoperative body mass index (BMI), smoking history, and preoperative comorbidities. Postoperative weight measurements were used to calculate TWL and WR outcomes. Statistical analyses included chi-square testing, one-way analysis of variance (ANOVA), and multivariable Cox regression models.

A total of 2207 qualified patients (80% female, mean age 47.8 ± 11.9 years, mean BMI 46.0 ± 8.2 kg/m²) were followed over a median of five years (interquartile range (IQR) 4-5). In this cohort, 1253 (56.8%) patients experienced WR > 20%; 60.4%, 57.4%, and 33.3% of whom underwent SG, RYGB and DS, respectively (p < 0.001). Notably, WR > 50% in SG, RYGB and DS was 24.3%, 15% and 5.1%. On multivariable analysis for WR > 20% in the RYGB subgroup, older age and a history of smoking were associated with a decreased risk of WR, whereas White race was associated with an increased risk. In SG and DS subgroups, no significant predictors of WR were identified.

Clinically significant WR occurred in more than half of SG and RYGB patients but was less frequent after DS. Preoperative predictors had limited value and varied by procedure, reinforcing procedure selection as a key modifiable factor in predicting WR risk.