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Surgery and mortality

Bariatric surgery reduces risk of cardiac arrest and stroke

Compared to nonsurgical controls, there was more than 50% reduction in mortality amongst bariatric patients

Bariatric surgery patients halve their risk of having a cardiac arrest, according to researchers from the University of East Anglia, the University of Manchester and the University of Aberdeen. The study, published in the International Journal of Cardiology, reviewed data from 14 studies involving more than 29,000 patients who underwent bariatric surgery. It reveals that mortality was reduced by 40 per cent, and that heart attacks in particular were reduced by half, compared to obese people who did not have surgery.

The researchers said that they believe the is the first comprehensive review of the impact of surgery on heart disease, stroke and death.

"We looked at the outcomes for patients who undergo bariatric surgery, and compared them to figures for obese people who had not received surgery,” said Senior author, Dr Yoon Loke from UEA's Norwich Medical School. “We saw that surgery was potentially life-saving and could lower the risk of having a heart attack and stroke by almost 50 per cent.”

The mean age of participants was 48 years old, and 30 per cent of participants were male. The original studies were carried out the North America, Europe and Australia, and patients were followed-up from two years to 14 years.

After conducting a literature search, they identified 14 studies that met the inclusion criteria, and this included 29,208 patients who underwent bariatric surgery and 166,200 non-surgical controls (mean age 48 years, 30% male, follow up period ranged from 2 years to 14.7 years).

They found that compared to nonsurgical controls, there was more than 50% reduction in mortality amongst patients who had bariatric surgery (OR 0.48 95% CI 0.35–0.64, I2=86%, 14 studies). In pooled analysis of four studies with adjusted data, bariatric surgery was also associated with a significantly reduced risk of composite cardiovascular adverse events (OR 0.54 95% CI 0.41–0.70, I2=58%).

Bariatric surgery was also associated with significant reduction in specific endpoints of myocardial infarction (OR 0.46 95% CI 0.30–0.69, I2 = 79%, four studies) and stroke (OR 0.49 95% CI 0.32–0.75, I2 = 59%, four studies).

"Obesity is a worldwide problem with significant consequences on individuals and society. It is associated with heart disease, type 2 diabetes, many cancers, and a shorter life expectancy,” added Loke. “The latest (UK) government figures from 2011 show that obesity affects about one in four people in the UK and this figure is growing. During 2011-12, the NHS reported 11,736 hospital admissions due to obesity, which represents an 11-fold increase compared to the 1,019 admissions in 2001-02.

"These findings suggest that surgery should be seriously considered in obese patients who have a high risk of heart disease. This is the right time for a large, high-quality trial of bariatric surgery in the NHS to confirm the potential benefits."

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