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ObesityWeek 16

Gastric bypass patients significantly reduce risk of dying

The study examined when early increased surgical risk is overcome by reductions in mortality risk over time that likely relate to improvements in metabolic health

Patients with severe obesity who have gastric bypass surgery reduce their risk of dying from obesity and other diseases by 48 percent up to ten years after surgery, compared to similar patients who do not undergo the procedure, according to research presented at ObesityWeek 2016. Researchers from the Geisinger Health System reported that the biggest reduction in risk occurred in patients 60 years or older at the time of surgery and in patients who had diabetes before surgery.

Michelle Lent

“The long-term survival benefits these older patients and those with diabetes experience likely relate to improvements in long-term metabolic and cardiovascular health, among other risk factors,” said Dr Michelle R Lent, a Geisinger Obesity Institute researcher, who presented her team’s findings. “While this study did not evaluate specific-cause mortality, as expected, we did find significant improvements or remission in diabetes and high blood pressure.”

The study paper, “Long-Term Mortality Risk Following Roux-en-Y Gastric Bypass (RYGB): A Case-Control Study,” the investigators assessed all-cause mortality risk up to ten years following RYGB compared to tightly matched controls with obesity seen in primary care from the Health System network. Additionally, they stratified mortality risk by patient characteristics, including diabetes that may increase the risk of mortality in severe obesity. The study also examined when early increased surgical risk is overcome by reductions in mortality risk over time that likely relate to improvements in metabolic health.

The study authors followed nearly 2,696 patients who had gastric bypass at the system’s nationally accredited bariatric surgery centre between 2004 and 2014 and matched controls were identified for these patients and were included in analyses. RYGB patients and controls were the same in age (46.1+-11.1 years), BMI (47.2+-6.2 kg/m2) and diabetes status (30%), and were predominately female (83%) and white (97%).

Median follow-up for RYGB (postoperatively) and control patients was 6.4 years (IQR=4.2-8.3). There were 94 deaths in RYGB patients and 133 deaths in controls during follow-up. Overall, Kaplan-Meier (curve estimates indicated that RYGB patients experienced a significant reduction in the risk of all-cause mortality compared to controls (p=0.0006). Kaplan-Meier estimated mortality rates were similar in the early follow-up period and started to diverge at year two, but first differed significantly at 39 months (RYGB: 1.3%, 95% CI=[0.9%, 1.8%], controls:     2.4%, 95% CI=[1.8%, 3.0%]). Using Cox regression, the significant reduction in the risk of all-cause mortality translated into a hazard ratio of 0.63 (95% CI=[0.49, 0.82]). When stratified by selected patient characteristics, the largest reduced mortality odds were observed within RYGB patients age 60+ years (HR=0.50, 95% CI=[0.31, 0.81], p=0.0048) and patients with diabetes (HR=0.48, 95% CI=[0.33, 0.70], p=0.0001).

Raul Rosenthal

“Obesity and related diseases kill and the data continues to confirm this fact,” said Dr Raul J Rosenthal, ASMBS President and Chairman, Department of General Surgery, Cleveland Clinic Florida, who was not involved in the study. “The good news is the Geisinger study shows we can do something about it. The long-term data on bariatric surgery provides the proof.”

“While bariatric surgery provides significant health benefits to most patients, it is important to note that in our study some of the strongest mortality risk reductions following gastric bypass were found in older adults,” added Lent. “Until recently, older age was viewed as a relative contraindication to bariatric surgery, as the benefits were less clear. Our findings help to challenge that myth and instead support offering the surgery to older patients.” 

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