Adults who undergo bariatric surgery have a lower risk of death than non-surgical controls

Adults who undergo bariatric surgery have a lower risk of all-cause mortality than those who do not, according to findings published in . obesity.

In a retrospective data analysis, researchers found Utah residents who underwent bariatric surgery between 1982 and 2018 had lower all-cause mortality and mortality from cardiovascular disease, cancer and diabetes. Did. A reduced risk of death was observed in men and women and in all adults over the age of 34 years.

“Major reduction in mortality from cardiovascular disease, cancer And diabetes supports reported findings that bariatric surgery improves pre-existing comorbidities such as diabetes and also reduces the incidence of CVD, cancer and diabetes. ” Dr. Ted D. Adams, M.P.H., Director of Intermountain Surgical Specialties/Digestive Health Clinical Program at Intermountain Healthcare in Salt Lake City. Adjunct professor in the Department of Epidemiology, Department of Internal Medicine, and Adjunct Associate Professor in the Department of Nutrition and Integrative Physiology at the University of Utah, he told Healio. “Reports of improved mortality may also stimulate additional research efforts aimed at discovering biomolecular mechanisms leading to non-surgical treatments for diseases such as severe obesity and diabetes.”

Ted D. Adams

Adams and colleagues obtained data from the Utah Population Database. The database contains population-based data, cancer registry records, and medical facility records, and is linked to medical records held by two of Utah’s largest health care providers. Adults who underwent bariatric surgery in Utah between 1982 and 2018 were identified from three major bariatric surgeries and the University of Utah and Intermountain Healthcare Enterprise Data His Warehouse. Those who underwent surgery were matched one-to-one with non-operated adults to her by sex, BMI, and age. The control group was selected from Utah driver’s license and ID card records. The year of surgery coincided with the year of driver’s license application or renewal.

Bariatric surgery reduces risk of all-cause mortality

21,837 adults who had bariatric surgery were matched with adults who had never had surgery. Of the surgical group, 69.2% underwent Roux-en-Y gastric bypass, 14% underwent sleeve gastrectomy, 12% underwent adjustable gastric banding, and 4.8% underwent duodenal switch.

During the 40-year follow-up period, 13.5% in the surgical group and 14.6% in the control group died. The surgery group had a lower risk of all-cause mortality than the non-surgery group (HR = 0.84; 95% CI 0.79-0.9; P. < .001). All-cause mortality risk was low for both women (HR = 0.86; 95% CI, 0.8-0.93; P. < .001) and men undergoing surgery (HR = 0.79; 95% CI, 0.69–0.9; P. < .001) compared to controls.

Adults who underwent surgery had a 26% lower risk of non-external death (P. < .001) and a 72% lower risk of death from diabetes (P. < .001) and a 29% lower risk of dying from CVD (P. < .001) and a 43% lower risk of dying from cancer (P. < .001) and a 39% lower risk of death from chronic lung disease (P. = .04) from the non-surgical group. Mortality from chronic liver disease was 83% higher in the surgery group compared with the control group (P. = .02). Also, in the surgical group, he had a 92% higher risk of dying from an accident or side effects (P. = .03) and a 140% higher risk of suicide (P. < .001).

When participants were stratified by age, adults who underwent surgery had a lower risk of death than controls at all ages except 18 to 34 years. The researchers noted that adults aged 18 to 34 who had bariatric surgery had a higher risk of death due to a higher rate of death from external causes.

Adams noted that the researchers did not extract any psychological, behavioral, or substance use data for the study, and future studies should examine why young adults are at higher risk of mortality and suicide. there is.

“Some researchers speculate that increased drug use after surgery may be a factor in the increased suicide rate.” , disinhibition and impulsivity may increase after certain types of bariatric surgery.Finally, patients undergoing surgery do not expect changes in specific or general behavioral aspects of their lives as a result of significant weight loss. and if results after surgery are not as expected, this can lead to mental health issues such as depression.”

Low risk of death for most surgical types

Adults undergoing gastric bypass after stratification by type of surgery (HR = 0.85; 95% CI, 0.79-0.91; P. < .001), gastric banding (HR = 0.72; 95% CI, 0.55-0.94; P. = .017) and sleeve gastrectomy (HR = 0.49; 95% CI, 0.3–0.79; P. = .004) had a lower risk of death than non-surgical controls. No difference in mortality risk with duodenal switch was observed.

The median survival time for all causes of death was 1.3 years longer in adults who underwent surgery compared with those who did not undergo surgery. The median survival time in the surgical group was 1.72 years longer for him than in the control group for non-external death, but 0.4 years shorter for him with external death.

Adams said more research is needed on nonsurgical treatments for obesity that are as effective as surgery, and the increased risk of death from chronic liver disease in surgical patients needs to be investigated.

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Ted D. Adams, PhD, MPH, can be reached by [email protected].