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Bariatric surgery and mortality

Bariatric surgery associated with reduction in all-cause mortality

The primary outcome, all-cause mortality, matched and adjusted for BMI prior to surgery, age, sex, socioeconomic status, diabetes, hyperlipidaemia, hypertension, cardiovascular disease, and smoking
There were 105 deaths (1.3%) among surgical patients and 583 deaths (2.3%) among non-surgical patients during a median follow-up of 4.0 years

Obese, middle-age men and women who had bariatric surgery have half the death rate of those who had traditional medical treatment over a 10-year period, according to a study assessing the long-term risk of bariatric surgery. The study was by Northwestern University Feinberg School of Medicine and the Clalit Research Institute in Israel.

In the study, ‘Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality’, published in JAMA, the study authors examined whether there was an association between undergoing bariatric surgery with laparoscopic gastric banding (LGB), Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG) vs non-surgical usual care management and all-cause mortality among patients with obesity

"We showed that a long-term effect of bariatric surgery is a longer life for obese patients," said study co-author, Dr Philip Greenland, professor of preventive medicine at Northwestern University Feinberg School of Medicine. "They had half the death rate, which is significant."

The study included 8,385 obese adult patients who underwent bariatric surgery between January 2005 and December 2014, and compared with 25,155 obese non-surgical patients matched on age, sex, BMI and diabetes, with a final follow-up date of December 2015. A total of 33,540 patients were included in this study. The primary outcome, all-cause mortality, matched and adjusted for BMI prior to surgery, age, sex, socioeconomic status, diabetes, hyperlipidaemia, hypertension, cardiovascular disease, and smoking.

The bariatric surgery cohort included 5,490 (65.5%) women and this patient group has a baseline median BMI40.6. A majority patients underwent LGB (n=3,635], gastric bypass (n=1,388), laparoscopic sleeve gastrectomy (n=3,362) and 25,155 non-surgical matched patients (median age, 16,470 (65.5%) women; baseline median BMI40.5).

The availability of follow-up data was 100% for all-cause mortality and there were 105 deaths (1.3%) among surgical patients during a median follow-up of 4.3 years (including 61 (1.7%) who underwent laparoscopic banding, 18 (1.3%) gastric bypass and 26 (0.8%) sleeve gastrectomy, and 583 deaths (2.3%) among nonsurgical patients during a median follow-up of 4.0 years. The absolute difference was 2.51 (95% CI, 1.86-3.15) fewer deaths/1000 person-years in the surgical vs nonsurgical group.

Adjusted hazard ratios (HRs) for mortality among nonsurgical vs surgical patients were 2.02 (95% CI, 1.63-2.52) for the entire study population; by surgical type, HRs were 2.01 (95% CI, 1.50-2.69) for laparoscopic banding, 2.65 (95% CI, 1.55-4.52) for gastric bypass, and 1.60 (95% CI, 1.02-2.51) for laparoscopic sleeve gastrectomy.

While the short-term benefits of weight loss surgery - such as weight loss and better control of diabetes and blood pressure - are well known, there is concern about complications from the surgery. Among the concerns are malabsorption of nutrients including vitamin deficiency, anaemia and protein deficiency. But there was not a higher rate of anaemia, vitamin or protein deficiency among those who had surgery in this study.

“Among obese patients in a large integrated health fund in Israel, bariatric surgery using laparoscopic banding, gastric bypass, or laparoscopic sleeve gastrectomy, compared with usual care nonsurgical obesity management, was associated with lower all-cause mortality over a median follow-up of approximately 4.5 years,” the authors concluded. “The evidence of this association adds to the limited literature describing beneficial outcomes of these 3 types of bariatric surgery compared with usual care obesity management alone.”

"Bariatric surgery is an increasingly frequent treatment for severe obesity," said study co-author, Dr Laura Rasmussen-Torvik, an assistant professor of preventive medicine at Feinberg. "It's highly effective in promoting weight loss but also invasive and can lead to short- and long-term complications. In order for patients and doctors to make the best-informed decisions about what weight loss strategies to pursue, they need to understand the true costs and benefits of the procedures."

"Surgery sounds like a radical approach to managing obesity, and a lot of people reject it because it seems like a risky thing to do, but it's actually less risky to have the surgery," added Greenland. 

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