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68; 95% CI0.62,0.75; inpatient aHR 0.61; 95% CI 0.53,0.72). SG patients also had lower odds of high ED and high total acute costs (e.g., year-1 acute costs aOR 0.77; 95% CI 0.66,0.9 in early follow-up. However, observed cost differences decreased by years 3 and 4 (e.g., year-4 acute care costs aOR 1.10; 95% CI 0.92,1.31). SG may have fewer complications requiring emergency care and hospitalization, especially as related to digestive system disease. However, any acute care cost advantages of SG may wane over time. SG may have fewe