Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers.
ABSTRACT The purpose of this study was to examine patient factors associated with mortality among veterans who undergo bariatric surgery.
Prospective study that uses data from the Veterans Affairs (VA) National Surgical Quality Improvement Program.
Group Health Center for Health Studies, the VA North Texas Health Care System, the Denver VA Medical Center, and the Durham VA Medical Center.
We identified 856 veterans who had undergone bariatric surgery in 1 of 12 VA bariatric centers from January 1, 2000, through December 31, 2006.
The risk of death was estimated via Cox proportional hazards.
The 856 veterans had a mean body mass index (BMI) of 48.7, a mean age of 54 years, and a mean DCG score of 0.76; 73.0% were men, 83.9% were white, and 7.0% had an ASA class equal to 4. Fifty-four veterans (6.3%) had died by the end of 2006. In our Cox models, patients with a BMI greater than 50 (superobesity; hazard ratio [HR], 1.8; P = .04) or a DCG score greater than or equal to 2 (HR, 3.4; P < .001) had an increased risk of death.
Superobese veterans and those with a greater burden of chronic disease had a greater risk of death after bariatric surgery from 2000 through 2006.
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ABSTRACT: The objective of this study was to identify determinants of significant weight loss one year after gastric bypass surgery among United States veterans. Using data from the Veterans Affairs (VA) Surgical Quality Improvement Program, we identified 516 veterans who had gastric bypass surgery (24% laparoscopic) in one of twelve VA bariatric centers in 2000â2006 and one or more postoperative weight measures. The probability of losing 30% or more of baseline weight at one year was estimated via logistic regression, examining the following potential predictor variables: age, gender, race, marital status, body mass index (BMI), American Society of Anesthesiologists class, comorbidity burden, smoking status, diabetes medications taken and surgical procedure (open or laparoscopic). The 516 cases had a mean BMI of 49 kg/m(2), mean age of 51.5 years, 74% were male, 77% were Caucasian, and 55% were married. The predicted mean weight loss was 76 (95% CI: 73â79) pounds (22%) at six months and 109 (95% CI: 104â114) pounds (32%) at one-year. Based upon estimated individual trajectories of 370 patients with adequate follow-up data, 58% of the sample lost 30% or more of their baseline weight at one year; and <1% lost <10% of their baseline weight at 1 year. In the logistic regression, patients were more likely to lose 30% or more of their baseline weight if they were female (odds ratio (OR) = 2.5, p < 0.01) or Caucasian (OR = 2.3, p < 0.01). We conclude that gastric bypass surgery yields significant weight loss for most patients in Veterans Affairs Medical Centers, but is particularly effective for female and Caucasian patients.:Obesity Research & Clinical Practice 09/2013; 7(5):e321-430. · 0.70 Impact Factor
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ABSTRACT: Despite similar rates of obesity among American men and women, population-based studies suggest that bariatric surgery patients are disproportionately female. We sought to assess this observation quantitatively. Data were prospectively collected from 1,368 consecutive patients evaluated for bariatric surgery over a 4-year period. The prevalence of diabetes mellitus (DM), hypertension (HTN), dyslipidemia (DYS), obstructive sleep apnea (OSA), gastroesophageal reflux disease, depression, back pain (BKP), and musculoskeletal peripheral disease was assessed. A severity score from 1 to 5 had been assigned to each comorbidity based on the Assessment of Obesity Related Comorbidities Scale (AORC). Metabolic syndrome (MetS) was defined as the concurrent presence of DM, HTN, and DYS. The majority of patients were female (n = 1,115, 81.5 %). Male patients were older (44.5 ± 9.5 vs. 42.6 ± 9.6 years, p = 0.0044) and had higher body mass index (48.7 ± 7.8 vs. 46.6 ± 7.4 kg/m(2), p < 0.0001). On average, men presented with 4.54 serious comorbidities and 3.7 complicated comorbidities (AORC score ≥3), whereas women presented with 4.15 serious comorbidities and 3.08 complicated comorbidities. More men presented with DM (36.4 vs. 28.9 %, p = 0.0154), HTN (68.8 vs. 55.3 %, p = 0.0001), OSA (71.9 vs. 45.7 %, p < 0.0001), and MetS (20.9 vs. 15.2 %, p = 0.0301). Men also presented with more complicated DM (33.2 vs. 23.9 %, p = 0.0031), DYS (36.8 vs. 23.5 %, p < 0.0001), HTN (58.9 vs. 44.6 %, p < 0.0001), BKP (25.3 vs. 19.3 %, p = 0.0378), OSA (56.9 vs. 30.1 %, p < 0.0001), and MetS (17.8 vs. 10.0 %, p = 0.001). Although men typically comprise less than 20 % of bariatric surgery patients, they potentially have more to gain from these operations. Men present later in life, with more advanced obesity, and with more complicated comorbidities. Such findings mandate more research and resources to investigate this barrier to treatment and to provide the morbidly obese male with the surgical care he clearly needs.Surgical Endoscopy 08/2013; · 3.31 Impact Factor
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ABSTRACT: The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m2. The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m2, and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m2, and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 06/2014; · 1.08 Impact Factor