Among obese patients receiving care in the Veterans Affairs health system, those who underwent bariatric surgery, compared with obese patients who did not have this surgery, had a lower all-cause rate of death at 5 years and up to 10 years following the procedure, according to a study in the January 6 issue of JAMA.
Bariatric surgery is associated with improvement in weight, obesity-related conditions, and quality of life among severely obese adults. Accumulating evidence suggests that bariatric surgery improves survival among patients with severe obesity, but these studies have examined lower-risk, predominantly female patients. The long-term outcomes of bariatric surgery on patients with substantial co-existing illnesses are not known, according to background information in the article.
David E. Arterburn, M.D., M.P.H., of the Group Health Research Institute, Seattle, and colleagues examined long-term survival among 2,500 patients (74 percent men) who underwent bariatric surgery in Veterans Affairs (VA) bariatric centers from 2000-2011 and matched them to 7,462 control patients who did not undergo bariatric surgery. Bariatric procedures included gastric bypass (74 percent), sleeve gastrectomy (15 percent), adjustable gastric banding (10 percent), and other (1 percent). Surgical patients had an average age of 52 years and an average body mass index (BMI) of 47; control patients had an average age of 53 years and an average BMI of 46.
At the end of the 14-year study period, there were a total of 263 deaths in the surgical group and 1,277 deaths in the control group. Estimated mortality rates for surgical patients were 2.4 percent at 1 year, 6.4 percent at 5 years, and 13.8 percent at 10 years; for control patients, estimated mortality rates were 1.7 percent at 1 year, 10.4 percent at 5 years, and 23.9 percent at 10 years. Bariatric surgery was not associated with all-cause mortality in the first year of follow-up, but associated with significantly lower mortality after 1 to 5 years and 5 to 14 years.
The researchers found no significant difference in the association of bariatric surgery on mortality across groups defined by sex, diabetes diagnosis, and super obesity (BMI greater than 50); "however, future studies with larger samples and longer-term follow-up should seek to confirm these findings."
The authors write that the results of this study "provide further evidence for the beneficial relationship between surgery and survival that has been demonstrated in younger, predominantly female populations."
(doi:10.1001/jama.2014.16968; Available pre-embargo to the media at http://media.
Editor's Note: 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. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
There will also be an author audio interview available for this study at JAMA.com at the embargo time.