Study shows significant reduction in mortality after bariatric surgery

A new retrospective study shows significant reductions in mortality rates from a variety of causes, including cardiovascular disease, diabetes and cancer, in patients undergoing bariatric surgery compared to non-surgical participants with severe obesity.

The data are from a large study, with up to 40 years of follow-up, published in the journal Obesity, the leading scientific journal of the Obesity Society (TOS).

The study also points to evidence that suggests an increased risk of death from chronic liver disease, as well as higher rates of death from suicide in younger patients who had bariatric surgery compared to non-surgical participants. The study authors note that the findings may lead to more thorough presurgical psychological screening and postoperative follow-up.

Researcher Ted D. Adams, from the University of Utah, in the United States, observes that the findings may not only increase interest in surgery, but, in addition, stimulate even more research related to the discovery of physiological and biomolecular mechanisms that result in indicators positive results from those who perform the non-surgical treatment.

extensive study

Previous research has established associations between bariatrics and mortality outcomes using different methodologies. In the new study, experts build on mortality outcomes reported by different groups after gastric bypass surgery, extending follow-up up to 40 years, tripling the number of surgical patients, and using four bariatric surgery procedures instead of one.

The researchers used information from the Utah Population Database (UPDB) for the current study. The UPDB includes linked US state population-based information with birth and death certificates, driver’s licenses, ID cards, and voter registration cards. The UPDB creates and maintains links between the database and medical records maintained by the two largest health care providers in Utah.

Patients who underwent bariatric surgery in Utah between 1982 and 2018 were identified in three large bariatric surgical practices in Salt Lake City and in medical records at the University of Utah and the Intermountain Healthcare Enterprise Data Warehouses. Non-surgical participants were selected from driver’s license or ID records. As driver’s licenses are generally renewed every five years, several records were available for selection for correspondence with bariatric surgeries.

Nearly 22,000 participants with and without bariatric surgery were matched for age, gender, body mass index (BMI) and surgery date with driver’s license/renewal date. Mortality rates were compared by a proportional hazards model and stratified by sex, type of surgery and age at surgery.

Whereas mortality after gastric bypass surgery was previously reported from 1984 to 2002, the new study extended the mortality follow-up to 2021. The four bariatric surgery procedures included Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy and biliopancreatic diversion.

Results

The results revealed that the all-cause mortality was 16% lower in patients who had bariatric surgery compared to non-surgical participants. Lower mortality was observed for both men and women.

Mortality after surgery versus no surgery decreased by 29%, 43% and 72% for cardiovascular disease, cancer and diabetes , respectively. Mortality rates for men and women from chronic liver disease were 83% higher in patients who had surgery compared to non-surgical participants. The risk rate for suicide was 2.4 times higher in surgery compared to non-surgical participants, mostly in subjects aged between 18 and 34 years at surgery.

“This important study adds to the growing evidence that bariatric surgery not only improves patients’ quality of life , but also increases your life expectancy. This work is expected to improve patients’ access to this effective treatment for obesity, which is still limited to just one percent of eligible patients,” says Jihad Kudsi, researcher in the bariatric surgery division of Duly Health and Care, who was not involved in the study.

“In addition, the study highlights the importance of providing more resources for pre-surgical psychological screening and postoperative follow-up, especially for younger patients,” he concludes.