Nasser H, et al. - Researchers used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database to assess patient factors that impact the decision between laparoscopic Roux-en-Y gastric bypass (LRYGB) vs laparoscopic sleeve gastrectomy (LSG). They found 252,117 (72.3%) LSG and 96,677 (27.7%) LRYGB cases. The following factors were identified to be related to undergoing LRYGB vs LSG: diabetes mellitus, gastroesophageal reflux disease, BMI ≥ 50 kg/m², American Society of Anesthesiology class > 3, obstructive sleep apnea, hypertension, and hyperlipidemia. LSG was more likely to be received by patients with kidney disease, black race, chronic steroid use, age ≥ 60 years, recent smoking history, chronic obstructive pulmonary disease, and coronary artery disease. Overall, obesity-associated comorbidities and higher BMI mainly drove the decision to perform LRYGB, whereas LSG was more likely a preferred choice for higher risk patients.