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Bariatric Surgery and All-Cause Mortality

JAMA; 2018 Jan 16; Reges, Greenland, et al

Bariatric surgery is associated with reduced all-cause mortality, according to a recent study that assessed the association of 3 common types of bariatric surgery compared with nonsurgical treatment with mortality and other clinical outcomes among obese patients. The retrospective cohort study included 33,540 adult obese patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014 and compared with obese nonsurgical patients matched by age, sex, body mass index (BMI), and diabetes, with a final follow-up date of December 31, 2015. The primary outcome was all-cause mortality.

Among the details:

  • 8,385 patients underwent bariatric surgery; laparoscopic banding (n=3,635), gastric bypass (n=1,388), laparoscopic sleeve gastrectomy (n=3,362), and 25,155 nonsurgical matched patients.
  • There were 105 deaths (1.3%) among surgical patients during a median follow-up of 4.3 years and 583 deaths (2.3%) among nonsurgical patients during a median follow-up of 4.0 years.
  • Absolute difference was 2.51 fewer deaths per 1,000 person-years in the surgical vs nonsurgical group.

Citation:

Reges O, Greenland P, Dicker D, et al. 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. JAMA. 2018;319(3):279–290. doi:10.1001/jama.2017.20513.

Commentary:

This study is remarkable in showing an effect of bariatric surgery on mortality. Most previous studies of bariatric surgery have had too short of a follow-up period to examine the effects of bariatric surgery on mortality. The one large study that has looked at this, which showed an improvement in mortality, had limited generalizability because most of the patients in the study were men who received a gastric bypass, neither of which are representative of either the current demographics of who gets gastric bypass or the procedures that are most often performed.1 In addition to decreased mortality, the current study showed a higher rate of resolution of diabetes, and a decrease in the development of diabetes and hypertension. Currently, the criteria for bariatric surgery are: BMI ≥ 40, or more than 100 pounds overweight; BMI ≥35 and at least 1 or more obesity-related co-morbidity.2 These criteria are based on a 20-year old NIH consensus report and there has been much in the literature suggesting that given the current evidence and improvements in bariatric surgery, these criteria are too stringent and should be re-examined.3— Neil Skolnik, MD

  1. Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62-70. doi:10.1001/jama.2014.16968.
  2. American Society for Metabolic and Bariatric Surgery. Who is a Candidate for Bariatric Surgery? https://asmbs.org/patients/who-is-a-candidate-for-bariatric-surgery. Accessed January 28, 2018.
  3. Dimick JB, Birkmeyer NJ. Rethinking eligibility criteria for bariatric surgery. JAMA. 2014;312(9):953-954. doi:10.1001/jama.2014.3836.

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