Gastric Bypass May Significantly Reduce Long-Term Mortality Risk

Ten-year risk for all-cause mortality was significantly lower for severely obese patients who underwent Roux-en-Y  gastric bypass (RYGB) compared with those who did not, researchers reported at ObesityWeek 2016.¹

For their study, researchers from the Geisinger Health System in Danville, Pennsylvania, followed 2996 patients with class III obesity (body mass index [BMI] > 40.0 kg/m²) who underwent RYGB from 2004 to 2014 and compared them with 2996 matched controls.

Patients had a mean age of 46 years and a mean BMI of 47.2 kg/m². Eighty-three percent were women, 30% had diabetes, and 96% were white. More than one-third were on statins, and about two-thirds were on antihypertensives.

During a median follow-up of 6.4 years, 94 deaths occurred in the RYGB group and 133 in the control group.¹ Mortality benefits began to emerge within 2 years after surgery and were significant at 39 months in Kaplan-Meier survival analyses (RYGB, 1.3% [95% CI, 0.9%-1.8%] vs controls, 2.4% [95% CI, 1.8%-3.0%].¹

Overall, RYGB was associated with a 33% reduction in risk for all-cause mortality (hazard ratio [HR]: 0.67; 95% CI, 0.53-0.87).¹ After adjustment for sex, age, BMI, diabetes, smoking, and use of statins or antihypertensives, the procedure was associated with a 37.5% reduction in mortality risk (HR: 0.625; 95% CI, 0.484-0.807).¹

Reduction in mortality risk was greatest among patients aged 60 years or older (HR: 0.50; 95% CI, 0.31-0.81) and those with diabetes (HR: 0.48; 95% CI, 0.33-0.70).¹

“The long-term survival benefits these older patients and those with diabetes experience likely relate to improvements in long-term metabolic and cardiovascular health, among other risk factors,” Michelle R. Lent, PhD, a Geisinger Obesity Institute researcher, who presented her team’s findings, said in the release.² “While this study did not evaluate specific-cause mortality, as expected, we did find significant improvements or remission in diabetes and high blood pressure.”

Additionally, the researchers found that more than 60% of patients with diabetes before surgery experienced remission about 5 years after the procedure.²

“While bariatric surgery provides significant health benefits to most patients, it is important to note that in our study some of the strongest mortality risk reductions following gastric bypass were found in older adults,” said Dr Lent.² “Until recently, older age was viewed as a relative contraindication to bariatric surgery, as the benefits were less clear. Our findings help to challenge that myth and instead support offering the surgery to older patients.”

The study, however, did have limitations, including its nonrandomized design and the fact that the population was predominantly white and conducted within a single center, thus limiting generalizability.¹  

References

1. Craig WG, Benotti PN, Mirshahi T, et al. Long-Term Mortality Risk Following Roux-en-Y Gastric Bypass (RYGB): A Case-Control Study. Abstract A110. Presented at: ObesityWeek 2016; October 31-November 4, 2016; New Orleans, LA.
2. 10-Year Data Shows Gastric Bypass Patients Significantly Reduce Risk Of Dying From Obesity And Other Diseases, New Study Suggests [news release]. Gainesville, FL: American Society for Metabolic and Bariatric Surgery (ASMBS) Newsroom; November 2, 2016. http://newswise.com/articles/view/664046. Accessed November 4, 2016.