Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients

Section of Bariatric Surgery, Division of General Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
Annals of Surgery (Impact Factor: 8.33). 09/2004; 240(3):416-23; discussion 423-4. DOI: 10.1097/01.sla.0000137343.63376.19
Source: PubMed


This study tested the hypothesis that weight-reduction (bariatric) surgery reduces long-term mortality in morbidly obese patients.
Obesity is a significant cause of morbidity and mortality. The impact of surgically induced, long-term weight loss on this mortality is unknown.
We used an observational 2-cohort study. The treatment cohort (n = 1035) included patients having undergone bariatric surgery at the McGill University Health Centre between 1986 and 2002. The control group (n = 5746) included age- and gender-matched severely obese patients who had not undergone weight-reduction surgery identified from the Quebec provincial health insurance database. Subjects with medical conditions (other then morbid obesity) at cohort-inception into the study were excluded. The cohorts were followed for a maximum of 5 years from inception.
The cohorts were well matched for age, gender, and duration of follow-up. Bariatric surgery resulted in significant reduction in mean percent excess weight loss (67.1%, P < 0.001). Bariatric surgery patients had significant risk reductions for developing cardiovascular, cancer, endocrine, infectious, psychiatric, and mental disorders compared with controls, with the exception of hematologic (no difference) and digestive diseases (increased rates in the bariatric cohort). The mortality rate in the bariatric surgery cohort was 0.68% compared with 6.17% in controls (relative risk 0.11, 95% confidence interval 0.04-0.27), which translates to a reduction in the relative risk of death by 89%.
This study shows that weight-loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients.

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    • "Lifestyle modifications can, at best, induce a 5-10% weight loss and improve obesity-related morbidities to a limited extent[10]. However, advancements of bariatric surgery in less invasive and safer techniques, along with the evidence-supported superior results over lifestyle modifications, rendered surgery a better treatment option111213. A recent meta-analysis found a 26 kg weight difference between surgical versus non-surgical treatment of morbidly obese patients in 1-2 years follow-up[14]. "
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    ABSTRACT: Background: Obesity is a major health concern in the Middle East and worldwide. It is among the leading causes of morbidity, mortality, health care utilization, and costs. With bariatric surgery proving to be a more effective treatment option for overweight and obesity, the need for systematic assessment of different procedures and their outcomes becomes necessary. These procedures have not yet been described in detail in our region. Objective: We aim to undertake a prospective study evaluating and comparing several surgical bariatric procedures in an Iranian population of morbid obese patients presenting to a specialized bariatric center. Methods: In order to facilitate and accelerate understanding of obesity and its complications, the Tehran Obesity Treatment Study (TOTS) was planned and developed. This study is a longitudinal prospective cohort study in consecutive patients undergoing bariatric surgery. TOTS investigators use standardized definitions, high-fidelity data collection system, and validated instruments to gather data preoperatively, at the time of surgery, postoperatively, and in longer-term follow-up. Results: This study has recruited 1050 participants as of September 2015 and is ongoing. Conclusions: This study will ensure creation of high-level evidence to enable clinicians to make meaningful evidence-based decisions for patient evaluation, selection for surgery, and follow-up care.
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    • "Changes in lifestyle with healthy habits, mainly based on nutritional changes and physical activity, are the key therapeutic recommendations for the initial treatment of obesity. These interventions achieve better results for mild obesity; however, for patients with more severe degrees of obesity, the only long-term effective treatment with significant and sustained weight loss, remission or improvement of comorbidities, and reduction in overall mortality rate is bariatric surgery (Buchwald et al. 2004; Christou et al. 2004; Sjöström et al. 2007). "
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    ABSTRACT: Robotic surgery is an emerging and promising technology in bariatric surgery. Current studies have confirmed its feasibility and safety with a relatively short learning curve. The advantages for the surgeon are already well established with better ergonomics. The potential benefits to the patient are still being studied. Robotic surgery seems to offer more advantages for complex cases, such as super obesity and revisional surgery.
    Full-text · Chapter · Aug 2015
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    • "For this study, the 10-year mortality rate was lower than the rate found in large population-based cohorts, but those included several other surgical techniques (3,7,8,26). The present cohort, with a mean patient age of 36.2±10.5 years, represents the youngest population ever studied (3,5,8,9,25,27), as well one with the lowest mean BMI (43.3 kg/m2) reported (5,8,25,27), only behind the cohorts of Sjöström et al. (3) and Adams et al. (9). These characteristics may explain, at least in part, our findings of low mortality rate. "
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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.
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