Article

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

ABSTRACT

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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    • "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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    • "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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