Is bariatric surgery beneficial in higher risk patients?

January 01, 0001

Is bariatric surgery beneficial in higher risk patients?

There is some evidence of a mortality benefit with bariatric surgery, but the data is primarily from younger female patient. These US researchers examined bariatric surgery and whether it is linked with a reduction in mortality in higher risk patients. They performed retrospective cohort study of bariatric surgery patients in Veterans Affairs medical centers, which included predominantly older, higher risk males. They compared 850 bariatric surgery patients with 41,244 nonsurgical controls. Cox proportional hazards models were utilized for analysis.

The researchers found: "Among patients who had bariatric surgery, the 1-, 2-, and 6-year crude mortality rates were, respectively, 1.5%, 2.2%, and 6.8% compared with 2.2%, 4.6%, and 15.2% for nonsurgical controls. In unadjusted Cox regression, bariatric surgery was associated with reduced mortality (hazard ratio {HR}, 0.64). After covariate adjustment, bariatric surgery remained associated with reduced mortality (HR, 0.80). In analysis of 1694 propensity-matched patients, bariatric surgery was no longer significantly associated with reduced mortality in unadjusted (HR, 0.83) and time-adjusted (HR, 0.94) Cox regressions."

The researchers concluded: "In propensity score-adjusted analyses of older severely obese patients with high baseline mortality in Veterans Affairs medical centers, the use of bariatric surgery compared with usual care was not associated with decreased mortality during a mean 6.7 years of follow- up."

This cohort of comparatively older, higher risk patients found no mortality benefit with bariatric surgery.

For the full abstract, click here.

JAMA 305(23):2419-2426, 15 June 2011 © 2011 American Medical Association
Survival Among High-Risk Patients After Bariatric Surgery. Matthew L. Maciejewski, Edward H. Livingston, Valerie A. Smith, et al.

Category: D. Digestive. Keywords: bariatric surgery, mortality, males, veterans, high risk, retrospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 01 July 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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