June 14, 2011 - The use of bariatric surgery among
older, severely obese men was not associated with a decreased risk of
death, according to a study in the June 15 issue of the Journal of the
American Medical Association (JAMA). The researchers add, however, that
many such patients may still choose the surgery, because of the strong
evidence of significant weight loss, illness reduction and better
quality of life.
"Obesity incidence has stabilized after decades of
rapid increases, whereas the prevalence of patients with a body mass
index (BMI) greater than 35 increased 39 percent between 2000 and 2005,
the prevalence of severe obesity (BMI greater than 40) increased 50
percent, and the prevalence of superobesity (BMI greater than 50)
increased 75 percent, according to the background on the research.
Obesity is difficult to treat, and bariatric
surgery is the most effective means to induce weight loss for the
severely obese. Consequently, obesity surgery rates rapidly increased in
tandem. To date, no study to our knowledge has examined the long-term
survival of high-risk patients who underwent bariatric surgery."
This study sought to determine whether bariatric
surgery is associated with reduced mortality among predominantly older
male high-risk patients at Veterans Affairs medical centers.
Mortality was examined for 850 veterans who had
bariatric surgery in January 2000 to December 2006 (average age 49.5
years; average BMI, 47.4) and 41,244 nonsurgical controls (average age
54.7 years; average BMI 42.0) from the same 12 Veteran Integrated
Service Networks; the follow-up was through December 2008.
Leading the study was Matthew L. Maciejewski,
Ph.D., who worked with colleagues at the Durham VA Medical Center,
Eleven of 850 surgical case patients (1.29 percent)
died within 30 days of surgery. The surgical case patients had lower
crude mortality rates than the nonsurgical controls (at 1 year, 1.5
percent vs. 2.2 percent; at 2 years, 2.2 percent vs. 4.6 percent; at 6
years, 6.8 percent vs. 15.2 percent ).
In unadjusted analysis, bariatric surgery was
associated with reduced mortality. However, in further analysis that
included 1,694 propensity-matched patients (using a statistical approach
to compare patients who appear to be "similar" in many ways, except for
one of the matched patients having had the operation), bariatric surgery
was not significantly associated with reduced mortality.
"Our results highlight the importance of
statistical adjustment and careful selection of surgical and nonsurgical
cohorts, particularly during evaluation of bariatric surgery according
to administrative data, the authors conclude.
Previous studies claiming a survival benefit for
bariatric surgery had limited clinical information to conduct detailed
risk adjustment or matching. The survival differences between the
bariatric surgery and control groups were modest in most previous
studies, so the beneficial effects of surgery may have been attenuated
if adjustment for confounders had been possible.
We demonstrated that risk adjustment with
regression analysis resulted in a significant association of surgery and
survival that was reduced when equivalence in baseline characteristics
improved via propensity matching in this high-risk patient group."
The researchers add that even though bariatric
surgery is not associated with reduced mortality among older male
patients, many patients may still choose to undergo bariatric surgery,
given the strong evidence for significant reductions in body weight and
co-existing illnesses and improved quality of life.
This study was presented at the Academy Health
Annual Research Meeting.
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