SADI-S in the United States: A First Comparative Safety Analysis of the MBSAQIP Database


The single anastomosis duodenoileal bypass with sleeve (SADI-S) is a relatively new
bariatric procedure. In the year 2020, the Metabolic and Bariatric Surgery Accreditation
and Quality Improvement Program (MBSAQIP) started reporting outcomes for SADI-S.


We aimed to study the perioperative safety of SADI-S and compare it to other established
bariatric procedures utilizing the MBSAQIP database.


Academic Hospital, United States.


The 2020 MBSAQIP Participant Use File (PUF) was used to evaluate SADI-S outcomes.
We included SADI-S primary cases and excluded revisions and concurrent operations.
A 5:1 propensity matched analysis (PMA) for 20 variables was performed to compare
the outcomes of the SADI-S to the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy
(SG) and a 2:1 PMA to the biliopancreatic diversion with duodenal switch (BPD/DS).


There were 255 primary SADI-S reported in 2020. After PMA, the only significant complications
between the RYGB and SADI-S cohorts were Clavien-Dindo grade 4a and 4b (0.1% and 1.4%
versus 1.6% and 7.1% respectively). SADI-S had more Clavien-Dindo grade 2, 4a, and
4b complications than the SG cohort (1.3% vs. 3.5%, P = 0.03; 0.2% vs. 1.6%, P = 0;
1.% vs. 7.1%, P = 0). When compared to BPD/DS, outcomes including readmission, reoperation
and intervention were not statistically significant.


SADI-S, in its early adoption stage, has a higher incidence of perioperative complications
than RYGB and SG. It has comparable 30 days outcomes to BPD/DS.

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