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Meta-analysis

Bariatric surgery safe and effective, despite complications

Reported death rates were lower than those cited in previous meta-analyses
Su-Hsin Chang

Bariatric surgery provides ‘substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients’, according to a study published in the journal JAMA Surgery.

Although the paper did acknowledge that risks of complication, reoperation, and death exist, the reported death rates were lower than those cited in previous meta-analyses.

“Weight-loss surgery provides substantial effects on weight loss and improves obesity-related conditions in the majority of bariatric patients, although risks of complication, reoperation and [death] exist, death rates are, in general, very low,” said review author Su-Hsin Chang, an instructor in the division of public health services at the Washington University School of Medicine, St Louis. “The extent of weight loss and risks are different across different procedures. These should be well communicated when the surgical option is offered to obese patients and should be well considered when making decisions.”

The researchers wanted to examine the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques, and undertook a literature search after which they included a total of 164 studies (37 randomised clinical trials and 127 observational studies).

Analyses included 161,756 patients with a mean age of 44.56 years and BMI 45.62. More than a quarter of patients had diabetes, nearly half had high blood pressure and almost 30 percent had high cholesterol. Seven percent had heart disease and 25 percent had sleep apnoea.

After they conducted a conducted random-effects and fixed-effect meta-analyses and meta-regression, the mortality rate within 30 days for randomized clinical trials was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%).

The reduction in BMI at five years post-surgery ranged from 12 to 17, the complication rate ranged from 10 to 17% (95% CI, 11%-23%) and the reoperation rate was 7% (95% CI, 3%-12%). The death rate ranged from 0.08 to 0.31%.

The researchers also found that diabetes, high blood pressure and sleep apnoea improved significantly. Between 86 percent and 92 percent of patients with diabetes experienced remission of the disease. The same happened for about 75 percent of those with high blood pressure. High cholesterol and heart disease were rolled back at slightly lower rates, but sleep apnoea disappeared or improved dramatically in more than 90 percent of those who had it pre-surgery.

Procedures

Gastric bypass surgeries were the most effective in terms of long-term weight loss, but the procedure had the highest complication rates. Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass. Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.

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