Clinical Outcomes after Bariatric Surgery: A Five-Year Matched Cohort Analysis in Seven US States
ABSTRACT Bariatric surgery is the most effective weight loss treatment, yet few studies have reported on short- and long-term outcomes postsurgery.
Using claims data from seven Blue Cross/Blue Shield health plans serving seven states, we conducted a non-concurrent, matched cohort study. We followed 22,693 persons who underwent bariatric surgery during 2003-2007 and were enrolled at least 6 months before and after surgery. Using logistic regression, we compared serious and less serious adverse clinical outcomes, hospitalizations, planned procedures, and obesity-related co-morbidities between groups for up to 5 years.
Relative to controls, surgery patients were more likely to experience a serious [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.8-2.0] or less serious (OR 2.5, CI 2.4-2.7) adverse clinical outcome or hospitalization (OR 1.3, CI 1.3-1.4) at 1 year postsurgery. The risk remained elevated until 4 years postsurgery for serious events and 5 years for less serious outcomes and hospitalizations. Some complication rates were lower for patients undergoing laparoscopic surgery. Planned procedures, such as skin reduction, peaked in postsurgery year 2 but remained elevated through year 5. Surgery patients had a 55% decreased risk of obesity-related co-morbidities, such as type 2 diabetes, in the first year postsurgery, which remained low throughout the study (year 5: OR 0.4, CI 0.4-0.5).
While bariatric surgery is associated with a higher risk of adverse clinical outcomes compared to controls, it also substantially decreased obesity-related co-morbidities during the 5-year follow-up.
- SourceAvailable from: Bruce n M WolfeSurgery for Obesity and Related Diseases 11/2013; 9(6):926–935. DOI:10.1016/j.soard.2013.01.023 · 4.94 Impact Factor
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ABSTRACT: Bariatric surgery can effectively reduce body weight and treat obesity associated metabolic diseases such as diabetes mellitus. There are also benefits for an individual's functional status and psychological health. A multi-disciplinary evaluation should be offered to the individual as the first essential step in considering bariatric surgery as a treatment. This evaluation should include a thorough medical assessment, as well as psychological and dietetic assessments. In this best practice article, we outline the current recommendations for referral for bariatric surgery. We also present the data for pre-operative assessment before bariatric surgery, with particular reference to cardiovascular disease and obstructive sleep apnoea. We describe the literature on outcomes after bariatric surgery, including the results for mortality, weight loss, remission of diabetes and associated endocrine disorders such as hypogonadism. Within this review, we will illustrate the impact of bariatric surgery on self-image, psychological health and perceived health and functional status. Finally, we briefly detail the potential complications of bariatric surgery, and offer advice on post-operative care and surveillance.Journal of clinical pathology 11/2012; 66(2). DOI:10.1136/jclinpath-2012-200798 · 2.55 Impact Factor
- Circulation 02/2013; 127(8):945-59. DOI:10.1161/CIRCULATIONAHA.112.103275 · 14.95 Impact Factor