Article

Long-term mortality of patients submitted to Roux-en-Y gastric bypass in Public Health System: high prevalence of alcoholic cirrhosis and suicides

Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery 01/2013; 26 Suppl 1:53-56. DOI: 10.1590/S0102-67202013000600012
Source: PubMed

ABSTRACT

Bariatric surgery is a valuable therapeutic option to severe obesity. Many researches have assessed the procedure efficiency on weight reduction, improvement in comorbidities and reduction of mortality. However, studies of late mortality and its causes are still necessary, mainly in the Brazilian population.
To assess late mortality, discriminating causes of death and its association with pre-operative characteristics in a series of patients submitted to bariatric surgery.
Data analyses of 248 patients submitted to Roux-en-Y gastric bypass through Public Health System, from one up to 12 years of follow-up. The analyzed variables were: gender, age by the time of the surgery, pre-operative body mass index, comorbidities and smoking. The information about mortality was obtained through the Mortality Information System. The deaths were categorized according to International Classification of Diseases 10 and statistics analysis was done through the software STATA TM 9.2.
There were nine deaths, five of them were female. The mean age of the patients who died was 48.3±8.4 years and the pre-operative body mass index was 56.0±7.4 kg/m². The causes of death were: alcoholic cirrhosis (n=2), suicide (n=2), infectious causes (n=2), respiratory insufficiency (n=1), agranulocytosis (n=1) and unknown causes (n=1). None of the deaths was directly related to the surgery and there was no association of the pre-operative characteristics in mortality.
There was not any association between late mortality and pre-operative characteristics. The high frequency of suicide and alcoholic cirrhosis mortality indicates the strict follow-up concerns, with appropriate psychological support to the patients.

Full-text preview

Available from: scielo.br
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nonalcoholic steatohepatitis is becoming a common cause of liver cirrhosis and a significant number of patients undergoing bariatric surgery suffer with it. There is currently lack of consensus among surgeons regarding safety of bariatric surgery in patients with liver cirrhosis and the best bariatric procedure in these patients. This review investigates published English language scientific literature systematically in an attempt to answer these questions. Eleven studies that reported experience of bariatric surgery in cirrhotic obese patients were included in this review. This review shows an acceptably higher overall risk of complications and perioperative mortality with bariatric surgery in cirrhotic patients. Surgeons must discuss the possibility of an unexpected intraoperative diagnosis of cirrhosis preoperatively with all bariatric surgery patients and agree on a course of action.
    No preview · Article · May 2015 · Obesity Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: The question of whether or not nonsurgical intentional or voluntary weight loss results in reduced mortality has been equivocal, with long-term mortality following weight loss being reported as increased, decreased, and not changed. In part, inconsistent results have been attributed to the uncertainty of whether the intentionality of weight loss is accurately reported in large population studies and also that achieving significant and sustained voluntary weight loss in large intervention trials is extremely difficult. Bariatric surgery has generally been free of these conflicts. Patients voluntarily undergo surgery and the resulting weight is typically significant and sustained. These elements, combined with possible non-weight loss-related mechanisms, have resulted in improved comorbidities, which likely contribute to a reduction in long-term mortality. This paper reviews the association between bariatric surgery and long-term mortality. From these studies, the general consensus is that bariatric surgical patients have: 1) significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups; 2) greater mortality when compared to the general population, with the exception of one study; 3) reduced cardiovascular-, stroke-, and cancer-caused mortality when compared to severely obese non-operated controls; and 4) increased risk for externally caused death such as suicide.
    No preview · Article · Oct 2015 · Current Atherosclerosis Reports
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prevalence of obesity has increased dramatically. Obese individuals may undergo bariatric surgery to lose excessive body fat and mitigate obesity-related comorbidities. However, bariatric patients are particularly vulnerable to substance use problems. We conducted a review to examine the prevalence change and factors associated with substance use and determine the association between substance use and health status after weight loss among bariatric patients.
    No preview · Article · Jan 2016