Obese patients who underwent bariatric surgery had a lower rate of all-cause mortality at 5 and 10 years after the procedure, as compared with those who opted not to have the surgery, according to data published in JAMA.
“Bariatric surgery is associated with improved weight, obesity-related comorbidities, and quality of life among severely obese adults,” David E. Arterburn, MD, MPH, of the Group Health Research Institute in Seattle, and colleagues, wrote. “No long-term randomized clinical trials have been completed, but there is accumulating observational evidence that bariatric surgery is associated with better long-term survival than usual care.”
To further evaluate long-term survival in patients who underwent bariatric surgery, the researchers conducted a retrospective cohort study of 2,500 patients (men, 74%; mean age, 52 years; mean BMI, 47) who underwent the procedure in Veterans Affairs (VA) bariatric centers from 2000 to 2011 along with 7,462 matched control patients (mean age, 53 years; mean BMI, 46). Main outcomes included all-cause mortality through December 2013.
During the 14-year study period, 263 deaths occurred in the surgical group (mean follow-up, 6.9 years) and 1,277 deaths occurred in the control group (mean follow-up, 6.6 years).
Results revealed mean estimated mortality rates of 2.4% at 1 year, 6.4% at 5 years and 13.8% at 10 years for patients who underwent bariatric surgery vs. 1.7% at 1 year, 10.4% at 5 years and 23.9% at 10 years for control patients.
No significant association between bariatric surgery and death from all causes was found during the first year of follow-up (adjusted HR=1.28; 95% CI, 0.98-1.68). Mortality was significantly lower, however, after 1 to 5 years (HR=0.45; 95% CI, 0.36-0.56) and 5 to 14 years (HR=0.47; 95% CI, 0.39-0.58) among patients who underwent bariatric surgery.
The researchers did not find significant differences in midterm (>1 to 5 years) and long-term (>5 years) associations between bariatric surgery and survival across subgroups defined by diabetes diagnosis, sex, period of surgery and super obesity (BMI greater than 50).
Bariatric procedures performed included gastric bypass (74%), sleeve gastrectomy (15%), adjustable gastric banding (10%), along with other procedures (1%).
“These results provide further evidence for the beneficial relationship between surgery and survival that has been demonstrated in younger, predominantly female populations,” the researchers wrote.
They noted, however, that larger studies with longer follow-up are needed to confirm their findings.