Bariatric surgery linked to decreased all-cause mortality

1. Veterans Affairs (VA) patients receiving bariatric surgery between 2000-2011 demonstrated lower all-cause mortality at 5 years and 10 years following the bariatric surgery operation.

2. This association between bariatric surgery and all-cause mortality was not associated with sex, diabetes, or super obesity.

Evidence Rating Level: 2 (Good)       

Study Rundown: Bariatric surgery is a relatively new surgical field focused on various procedures intended to produce drastic weight loss in obese individuals. Natural weight loss by diet and exercise is commonly known to decrease all-cause mortality. While bariatric surgery has been shown to produce similar results, these prior studies had largely focused on low-risk and female populations. In contrast, this study examined the long-term effects of bariatric surgery in Veterans Affairs (VA) patients, a population that is predominantly male in gender and one that characteristically bears numerous comorbidities.

This study found that VA patients who received bariatric surgery between 2000-2011 demonstrated a statistically significant reduction in all-cause mortality during follow-up. Further, it showed that those receiving bariatric surgery in earlier years were at an increased risk of operative and postoperative mortality in the first postoperative year than those receiving surgery in recent years. A major strength of the study was its relatively long, 11-year study period and the large patient population it examined. While this study is limited by its retrospective design, it importantly suggests that the positive effects of bariatric surgery previously noted in female and low-risk populations may additionally apply to male patients and patients with high comorbidity burdens, as well.

Click to read the study, published today in JAMA

Relevant Reading: Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects

In-Depth [retrospective cohort study]: This study involved 2,500 VA patients who underwent bariatric surgery between 2000-2011 paired with 7,462 matched control patients. About 74% of the surgical patients were men. There were a total of 263 deaths in the surgical group (mean follow-up 6.9 years) and 1,277 in the control group (mean follow-up 6.6 years). Kaplan-Meier estimated mortality rates were 2.4% at 1 year, 6.4% at 5 years, and 13.8% at 10 years for surgical patients. For controls, mortality rates were 1.7% at 1 year, 10.4% at 5 years, and 23.9% at 10 years. Bariatric surgery was not associated with reduced all-cause mortality in the first year of follow-up (HR 1.28; 95%CI 0.98-1.68), but was associated with lower mortality at 1 to 5 years (HR 0.45; 95%CI 0.36-0.56) and >5 years of follow-up (HR 0.47; 95%CI 0.39-0.58).

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