Bariatric Surgery Improves Health Outcomes, Reduces All-Cause Mortality

HealthDay News — Obese patients who undergo bariatric surgery have reduced all-cause mortality; and obese adults with type 2 diabetes who undergo gastric bypass have improved outcomes compared with lifestyle and intensive medical management alone, according to 2 studies published in the Journal of the American Medical Association.

Orna Reges, PhD, from the Clalit Research Institute in Tel Aviv, Israel, and colleagues examined mortality and other outcomes among 8385 obese patients who underwent bariatric surgery (laparoscopic banding, 3635 patients; gastric bypass, 1388 patients; and laparoscopic sleeve gastrectomy, 3362 patients) who were matched with 25,155 nonsurgical patients.

The researchers found that deaths occurred in 1.3% of surgical patients and 2.3% of nonsurgical patients in a median follow-up of 4.3 and 4.0 years, respectively. The absolute difference in the surgical vs nonsurgical group was 2.51 fewer deaths/1000 person-years.

Sayeed Ikramuddin, MD, from the University of Minnesota in Minneapolis, and colleagues compared the durability of Roux-en-Y gastric bypass added to intensive lifestyle and medical management in achieving diabetes control targets in 120 patients with a hemoglobin A1c (HbA1c) level of 8.0% or higher and a body mass index between 30.0 and 39.9 kg/m².

The researchers found that 23% of patients in the gastric bypass group and 4% in the lifestyle-intensive medical management group had achieved the composite triple end point (HbA1c <7.0%, low-density lipoprotein cholesterol <100 mg/dL, and systolic blood pressure <130 mm Hg) at 5 years.

“Further follow-up is needed to understand the durability of the improvement,” Ikramuddin and colleagues write.

Several authors from the Ikramuddin study disclosed financial ties to the pharmaceutical and medical device industries.

References

1. Reges O, Greenland P, Dicker D, et al. Association of bariatric surgery using laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy vs usual care obesity management with all-cause mortality. JAMA. 2018; 319(3)279-290.
2. Ikramuddin S, Korner J, Lee WJ, et al. Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A_1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. JAMA. 2018; 319(3): 266-278.