Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures

Department of Health Services, University of Washington Seattle, Seattle, Washington, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/2005; 294(15):1903-8. DOI: 10.1001/jama.294.15.1903
Source: PubMed


Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown.
To evaluate the risk of early mortality among Medicare beneficiaries and to determine the relative risk of death among older patients.
Retrospective cohort study.
All fee-for-service Medicare beneficiaries, 1997-2002.
Thirty-day, 90-day, and 1-year postsurgical all-cause mortality among patients undergoing bariatric procedures.
A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged > or =75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index.
Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients.

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    • "However, there is no consensus on the upper age limit in the literature, and values ranging from 50 to 65 years have been suggested. Morbid obesity in patients aged 460 years is a real health problem, with more frequent weight-comorbidities [10] [11], greater medication use, and a higher mortality rate [12] [13]. A recent study reported that 10.1% of all bariatric operations in academic centers were performed on patients aged Z60 years [14]. "
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    ABSTRACT: Current guidelines consider that bariatric surgery is relatively contra-indicated in elderly adults (over the age of 60).Objective To evaluate obesity-related morbidity following sleeve gastrectomy (SG) according to whether patients were over or under the age of 60.SettingA public-sector university hospital in France.Methods Forty-two patients over the age of 60 (the elderly group) were matched 1:2 with 84 patients under 60 (the control group). The primary objective was to compare weight change and the remission rate of comorbidities in the two groups after 24 months of follow-up. The secondary endpoints were short- and mid-term postoperative outcomes (operating time, the frequency of conversion to laparotomy, the length of hospital stay, postoperative complications, mortality and the SG failure rate).ResultsWe did not observe any significant differences between the elderly and control groups in terms of the mean operating time (83 minutes in both groups; p=0.90), length of stay (3.2 vs. 3.4 days, respectively; p=0.51), morbidity rate (4.7% vs. 9.5%, p=0.35) or mortality rate (0% in both groups). The mean excess weight loss was significantly lower in the elderly group than in the control group at 12 months (56.2% vs. 71.4%, respectively; p<0.01) and 24 months (51.8% vs. 73.5%, p<0.01). We observed similar, statistically significant remissions of metabolic syndrome in the elderly and control groups (95% vs. 90%, respectively; p=0.55), type 2 diabetes mellitus (87% vs. 71%, p=0.13), hypertension (81% vs. 77%, p=0.71) and dyslipidemia (94% vs. 74%, p=0.09) at 24 months after SG.Conclusion Our results demonstrate the safety and efficacy of SG for morbid obesity in patients over the age of 60. In contrast to weight loss, the long-term morbidity rate and remission of obesity-related comorbidities were similar in over-60 and under-60 patients.
    Full-text · Article · Nov 2014 · Surgery for Obesity and Related Diseases
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    • "Furthermore, women with androgen excess as seen in polycystic ovarian syndrome (PCOS) gain as much benefit from bariatric surgery as women without PCOS [33]. On the other hand, male sex has previously been associated with a higher risk of post-operative adverse outcomes in some reports [34] [35] [36] [37]. However, this is not a universal finding as other studies have not found statistically significant differences in the incidence of these detrimental events [38]. "
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    ABSTRACT: Background: Despite the high prevalence of morbid obesity, the global frequency of bariatric surgery in men is significantly lower than in women. It is unclear if this is due to the perception of poorer outcomes in men. Objectives: Compare weight loss and metabolic outcomes in men vs. women after bariatric surgery. Setting: University teaching hospital in North West England. Methods: We performed an observational cohort analysis of 79 men matched to 79 women for baseline age (±5 years), body mass index (BMI; ±2 kg/m2), bariatric procedure (69 gastric bypass and 10 sleeve gastrectomy each), type 2 diabetes (33 each), and continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA; 40 each). Results: Overall mean (95% confidence interval) reduction in BMI was 17.5 (15.7–19.4) kg/m2 (P < 0.001) at 24 months. There was no significant difference between men and women in mean percentage excess BMI loss (65.8% vs. 72.9%) at 24 months. Likewise, there were significant reductions in blood pressure, glycosylated haemoglobin and total cholesterol-to-high density lipoprotein cholesterol overall but no significant gender differences. Postoperatively, 77.5% of men and 90.0% of women with OSA discontinued CPAP therapy (non-significant). Conclusions: Weight loss and metabolic outcomes after bariatric surgery are of similar magnitude in men compared to women. The use of bariatric surgery in eligible men should be encouraged.
    Full-text · Article · Nov 2014 · European Journal of Internal Medicine
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    • "The mortality rates varies between .1% and 2% [31] [32] [33] [34] [35]. According to some specialists, the factors that most contribute to increased risk of mortality are advanced age, male gender, and severe obesity (BMI 450 kg/m 2 ) [15]. The overall rate of conversion was .17%, "
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    ABSTRACT: Background Surgical treatment of morbid obesity with laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically challenging and involves high-risk patients. In this study, the short-term outcome of LRYGB in a large population of patients has been evaluated, and morbimortality before and after overcoming the learning curve has been assessed. The objective of this study was to establish the learning curve for laparoscopic Roux-en-Y gastric bypass. Methods This retrospective study involved 2281 patients submitted to LRYGB at São José do Avaí Hospital between August 1999 and December 2011. The parameters analyzed were operating time, rates of short-term postoperative complications, mortality, and conversion. Results The study population was predominantly female (71.3%) and presented a mean age of 37.5 years and mean body mass index (BMI) of 45.15 kg/m2. The average time in surgery was 119 minutes, and average hospital stay was 4.3 days. The incidence of postoperative complications (hemorrhage, fistula, and bowel obstruction) was 1.75%. The relative risk of complications diminished in line with the increased experience of the surgical team and tended to stabilize at<2.5% after the first 500 procedures. The mortality rate was .43%, and the main causes of death were pulmonary embolism and leaks (.14% each). The conversion rate was .17%. Conclusion Operating time and risks of adverse outcome were significantly reduced after a long learning curve of 500 consecutive procedures. The number of surgeries performed and the standardization of the laparoscopic technique used were the main factors contributing to the low rates of postoperative complications, mortality, and conversion.
    Full-text · Article · Feb 2013 · Surgery for Obesity and Related Diseases
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