New research published in Obesity shows that bariatric surgery significantly reduces death rates from all causes and cause-specific conditions like cardiovascular disease, diabetes, and cancer in patients who have undergone the procedure compared to non-surgical participants with severe obesity. The study followed participants for up to 40 years.
The study also found that younger people who had bariatric surgery had a higher risk of death from chronic liver disease and a higher rate of suicide compared to younger people who didn’t have surgery. The authors of the research point out that the results of higher suicide rates among younger bariatric surgery patients may encourage more intensive pre-surgical psychiatric evaluation and post-surgery follow-up.
Due to the fact that bariatric surgery has been effective for decades in reducing death from all causes and lowering deaths from heart disease, diabetes, and cancer compared to matched participants, researchers say that the findings may not only increase interest in bariatric surgical treatment for patients with severe obesity but also encourage important research into the physiologic and biomolecular mechanisms that lead to death from causes other than surgery.
Multiple association studies between bariatric surgery and mortality outcomes have been reported, primarily retrospectively, with wide variation in study design with respect to participant number, control cohorts, mean follow-up, procedure type, age at surgery, clinical endpoints such as life expectancy and death rates for all causes and specific causes, and the presence or absence of prevalent diabetes. The new study builds on what other groups have said about death rates after gastric bypass surgery. It does this by keeping track of patients for 40 years, tripling the number of people who had surgery, and using four bariatric surgery procedures instead of just one.
For this particular study, researchers looked at data obtained from the Utah Population Database (UPDB). The UPDB has linked, population-based information from Utah, such as birth and death certificates, voter registration cards, driver’s licenses and other forms of ID. The UPDB makes and keeps links between the database and the medical records kept by the two largest healthcare providers in Utah.
Three sizable bariatric surgical practices in Salt Lake City, Utah, as well as medical information from the University of Utah and Intermountain Healthcare Enterprise Data Warehouses in Salt Lake City, were used to identify patients who had had bariatric surgery in Utah between 1982 and 2018. Participants who were not undergoing surgery were chosen from Utah ID cards or driver’s license data. Since most people have to renew their driver’s licenses every five years, there were a lot of records to choose from to match with the bariatric surgeries.
For this study, over 22,000 people were matched (1:1) based on age, sex, BMI, and the date of bariatric surgery with a driving license/renewal date. Cox regression was used to compare death rates by gender, type of surgery, and age at surgery. Previous studies on mortality following gastric bypass surgery only reported results through 2002; this new research continues the mortality follow-up until 2021. Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch were the four types of weight loss surgery.
All-cause mortality was 16% lower in people who had bariatric surgery compared to people who didn’t have surgery. Both men and women saw their death rates go down. When compared to not having surgery, mortality from diabetes, cancer, and cardiovascular disease fell by 29%, 43%, and 72%, respectively. Males and females with chronic liver disease were 83% more likely to die after surgery than those who didn’t have surgery. The risk of suicide was 2.4 times higher in people who had surgery than in people who didn’t have surgery. This was especially true for people who had surgery between the ages of 18 and 34.
“This important study adds to the mounting evidence that bariatric surgery, not only improves quality of life for patients, but will also increase their life expectancy,” comments Jihad Kudsi, MD, MBA, MSF, DABOM, FASMBS, FACS, Bariatric Surgery Division, Duly Health and Care, Downers Grove, Ill. Kudsi who was not involved in the study.
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