Bariatric Surgery Halved 10-Year Mortality, VA Study Suggests

Ricki Lewis, PhD

January 07, 2015

Bariatric surgery is associated with lower all-cause mortality 5 to 10 years after the procedure among an adult, predominantly male population, according to a study published in the January 6 issue of JAMA.

The effect of weight-loss surgery on longevity has become easier to assess as more people have had the procedures. Previously, the Swedish Obese Subjects Study showed that it takes a decade to observe surgery-related lower mortality.

Because past studies on veterans had not shown a survival advantage at 5 years, David E. Arterburn, MD, MPH, from the Group Health Research Institute, Seattle, Washington, and colleagues evaluated a larger population over the course of a longer period of time. They compared 2500 patients (74% men) who had surgery in Veterans Affairs (VA) bariatric centers between 2000 and 2011 with 7462 control patients matched for age, sex, geographic region, presurgery body mass index, diabetes, and diagnosis.

The mean age of the patients was 52 years, and the patient population had more obesity-related comorbidities (including diabetes, hypertension, heart disease, arthritis, and depression) than most of the younger, female participants included in other studies of the effects of bariatric surgery on mortality. The patients also had higher prevalence of obesity-related conditions than the matched control participants.

The procedures included gastric bypass (74%), sleeve gastrectomy (15%), adjustable gastric banding (10%), and other (1%).

At 1 year, Kaplan-Meier estimated mortality rates were 2.4% for the surgical patients and 1.7% for the control participants. At 5 years, it was 6.4% for patients and 10.4% for control participants, and at 10 years, it was 13.8% for surgical patients and 23.9% for control participants.

Adjusted analysis revealed no significant association between surgery and mortality after 1 year (adjusted hazard ratio, 1.28; 95% confidence interval [CI], 0.98 - 1.68) but significantly lower mortality by 5 years (adjusted hazard ratio, 0.45; 95% CI, 0.36 - 0.56) and between 5 and 14 years (adjusted hazard ratio, 0.47; 95% CI, 0.39 - 0.58).

Surgery was associated with lower long-term mortality for both super obese (body mass index, ≥50 kg/m2) patients and less obese (body mass index, <50 kg/m2) patients. The association with lower mortality was higher for patients with diabetes compared with those without diabetes.

The researchers conclude that patients who have bariatric surgery have a 53% lower risk for all-cause mortality 5 to 14 years after the procedure. They write, "Despite changes in patient selection and bariatric procedure types and increased use of laparoscopic procedures that have lowered operative and early postoperative risks over time, we found similar associations with mortality in patients undergoing bariatric surgery in 2000-2005 and 2006-2011 after follow-up intervals of 1 year to 5 years and more than 5 years to 8 years."

Limitations of the study include missed confounders resulting from the nonrandomization and retrospective nature of the investigation, identification of associations and not causes, and reliance on diagnostic codes that do not indicate severity.

This research was funded by the Health Services Research and Development, Department of Veterans Affairs, and by a research career scientist award from the Department of Veterans Affairs. One coauthor reported receiving fees from the Journal of Clinical Investigation. Another coauthor reported receiving fees from Apollo Endosurgery, Bariatric Fusion, Cooper Surgical, and Covidien. Another coauthor reported receiving consulting fees from Daichi Sankyo and owners Amgen stock. The other authors have disclosed no relevant financial relationships.

JAMA. 2015;313:62-70. Abstract

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