Comprehensive study with 40 years of follow-up highlights long-term benefits of bariatric surgery

Drawing on 40 years of follow-up data, a retrospective study is providing insight into the durability of effects and the magnitude of risk reduction provided by bariatric surgery.

Using data from 21,837 surgical and non-surgical pairs, study results indicate that the risk of all-cause mortality was 16% lower in those who underwent a bariatric procedure compared to their peers who did not, with results also pointing to a 29% reduction in risk of cardiovascular disease mortality and a 72% reduction in risk of diabetes-related mortality. However, the investigators point to the risk of suicide as a cause for concern, which was 2.4 times higher in the surgery group.

“The results of this study attest to the decades-long durability of bariatric surgery in reducing all-cause deaths and reducing deaths related to cardiovascular disease, cancer, and diabetes when compared to severely obese matched participants,” the researchers wrote. “In addition, favorable mortality outcomes were evident for major bariatric surgery procedures. Serious concern, however, continues to be displayed regarding increased mortality after bariatric surgery in relation to suicide, accidents and cirrhosis of the liver.”

Led by Ted D. Adams, PhD, MPH, University of Utah and Intermountain Healthcare, the current study was launched with the intent of capturing and reporting data related to long-term mortality among patients undergoing bariatric surgery. With this in mind, the study was designed as a retrospective study of data from the Utah Population Database, which includes linked information based on the Utah population with statewide birth and death certificates, driver’s licenses, and driver’s licenses. identity and voter cards. From the database, which maintains links between the database and medical records maintained by the 2 largest healthcare providers in Utah, the investigators identified a cohort of more than 27,000 with a history of bariatric surgery between 1982 and 2018 for inclusion in your study.

For analysis purposes, those who underwent bariatric surgery were matched in a 1:1 ratio based on age, sex, BMI and date of surgery with date of application/driver license renewal. The outcome of interest for the study was all-cause mortality and cause-specific mortality, including mortality from risk related to cardiovascular disease, cancer, and diabetes. The investigators noted that mortality rates were estimated using Cox regression and stratified according to patient sex, type of surgery, and age at surgery.

After matching, the investigators identified a cohort of 21,837 surgical and non-surgical matched pairs for inclusion in their study. For the non-surgical cohort, mean age at index was 42.3 (SD, 11.9) years, mean BMI at index date was 46.2 (SD, 6.8) kg/m2, 87, 6% of the cohort were white and 79.1% were female. For the surgical cohort, mean age at index was 42.2 (SD, 11.7) years, mean BMI at index date was 46.0 (SD, 8.3) kg/m2, 94.4 % of the cohort was white and 79.1% were female. The mean follow-up time for the study cohort was 13.2 (SD, 9.5) years.

Upon analysis, the results indicated that bariatric surgery was associated with a 16% reduction in the risk of all-cause mortality relative to those who did not undergo bariatric surgery (HR, 0.84 [95% CI, 0.70-0.90]; P <.001). Analysis of cause-specific mortality indicated a significantly lower mortality rate seen in the bariatric surgery group compared to their peers who did not undergo surgery, with reductions of 29%, 43%, and 72% for cardiovascular disease, cancer, and diabetes. , respectively. However, the investigators highlighted an apparent increase in the risk of suicide, with results suggesting that patients who underwent bariatric surgery had a more than 2-fold increased risk compared to their peers who did not undergo surgery. Further analyzes indicated that this risk was most apparent among those who underwent surgery between the ages of 18 and 34.

“This important study adds to the growing evidence that bariatric surgery not only improves patients’ quality of life, but also increases their life expectancy. This work is expected to improve patient access to this effective obesity treatment, which is still limited to just one percent of eligible patients. Furthermore, the study highlights the importance of providing more resources for pre-surgical psychological screening and post-operative follow-up, especially for younger patients,” said Jihad Kudsi, MD, Division of Bariatric Surgery at Duly Health and Care, who did not was associated with the research, in a statement by The Obesity Society.

This study, “Long-term All-Cause and Cause-Specific Mortality for Four Bariatric Surgery Procedures,” was published in Obesity.

Comprehensive study with 40 years of follow-up highlights long-term benefits of bariatric surgery

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