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Suicide, coronary heart disease contribute to increased risk of death following bariatric surgery
October 16, 2007Approximately 1 percent of Pennsylvania residents who underwent bariatric surgery between 1995 and 2004 died within one year of the surgery and nearly 6 percent died within five years, according to a report in the October issue of Archives of Surgery, a theme issue on bariatric surgery. Death rates overall, as well as deaths from heart disease and suicide, were higher than those of the general state population.
Bariatric surgery has emerged as an effective treatment for severe obesity, according to background information in the article. Obese individuals typically lose up to 80 percent of their excess body weight one to two years after the operation. "Bariatric surgery results in clinical improvement and resolution of the obesity-related comorbid diseases," the authors write, including diabetes, high blood pressure and high cholesterol.
Bennet I. Omalu, M.D., M.P.H., of the University of Pittsburgh, and colleagues analyzed data on all bariatric operations performed on Pennsylvania residents between 1995 and 2004. Following 16,683 operations, 440 patients (2.6 percent) died.
"Age- and sex-specific death rates after bariatric surgery were substantially higher than comparable rates for the age- and sex-matched Pennsylvania population," the authors write. "This continued high mortality rate is likely a function of the initial comorbidities related to substantial obesity and the likelihood that the patients remain obese even after the substantial weight loss and have remaining comorbidities."
The researchers found that:
* Less than 1 percent of the deaths occurred within the first 30 days after surgery.
* The one-year case fatality rate was approximately 1 percent and at 5 years, the cumulative case fatality was 6.4 percent.
* Death rates increased with age, especially among patients older than 65; the average age at surgery was 48 years.
* Heart disease was the leading cause of death, cited for 76 patients (19.2 percent). Rates of death from heart disease were higher among bariatric surgery patients than the general population.
* Of 45 deaths from traumatic causes, 16 (4 percent of all deaths) were suicides and 14 (3 percent) were drug overdoses not classified as suicides. Based on national statistics for the general population, only two suicide deaths would have been expected among this number of individuals.
"It is likely that this continued excess mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes mellitus, hyperlipidemia [high cholesterol] and smoking, as well as efforts to prevent weight regain by diet and exercise and psychological support to prevent and treat depression and suicide," the authors conclude.
JAMA and Archives Journals
"Age- and sex-specific death rates after bariatric surgery were substantially higher than comparable rates for the age- and sex-matched Pennsylvania population," the authors write. "This continued high mortality rate is likely a function of the initial comorbidities related to substantial obesity and the likelihood that the patients remain obese even after the substantial weight loss and have remaining comorbidities."
The researchers found that:
* Less than 1 percent of the deaths occurred within the first 30 days after surgery.
* The one-year case fatality rate was approximately 1 percent and at 5 years, the cumulative case fatality was 6.4 percent.
* Death rates increased with age, especially among patients older than 65; the average age at surgery was 48 years.
* Heart disease was the leading cause of death, cited for 76 patients (19.2 percent). Rates of death from heart disease were higher among bariatric surgery patients than the general population.
* Of 45 deaths from traumatic causes, 16 (4 percent of all deaths) were suicides and 14 (3 percent) were drug overdoses not classified as suicides. Based on national statistics for the general population, only two suicide deaths would have been expected among this number of individuals.
"It is likely that this continued excess mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes mellitus, hyperlipidemia [high cholesterol] and smoking, as well as efforts to prevent weight regain by diet and exercise and psychological support to prevent and treat depression and suicide," the authors conclude.
JAMA and Archives Journals
Bariatric Surgery Current Events and Bariatric Surgery News RSSDiabetes surgery summit consensus lays foundation for new field of medicine
A first-of-its-kind consensus statement on diabetes surgery is published online today in the Annals of Surgery.
Energy gap useful tool for successful weight loss maintenance strategy
Americans continue to get heavier. Most weight control methods short of bariatric surgery are generally considered ineffective in preventing obesity or reducing weight.
Addressing obesity via the 'energy gap'
The November issue of the Journal of the American Dietetic Association features a commentary by James O. Hill, an honorary ADA member, professor of pediatrics and medicine and director of the Center for Human Nutrition at the University of Colorado-Denver.
'Superobesity,' chronic disease burden associated with risk of death following bariatric surgery
Veterans classified as superobese and those with a higher chronic disease burden appear more likely to die within a year of having bariatric surgery, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
NIH study finds low short-term risks after bariatric surgery for extreme obesity
Short-term complications and death rates were low following bariatric surgery to limit the amount of food that can enter the stomach, decrease absorption of food or both, according to the Longitudinal Assessment of Bariatric Surgery (LABS-1).
Study: Bariatric surgery patients have 67 percent lower chance of complications at top hospitals
The HealthGrades Fourth Annual Bariatric Surgery Trends in American Hospitals Study released today identifies 88 hospitals as "best" performers (five-star rated), with mortality rates, complication rates and patient lengths of stay that are dramatically lower than poorly rated hospitals.
A simpler definition for major depressive disorder
Researchers from Rhode Island Hospital's department of psychiatry propose that the definition for major depressive disorder (MDD) should be shortened to include only the mood and cognitive symptoms that have been part of the definition in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the past 35 years.
Roux-en-Y weight loss surgery raises kidney stone risk
The most popular type of gastric bypass surgery appears to nearly double the chance that a patient will develop kidney stones, despite earlier assumptions that it would not, Johns Hopkins doctors report in a new study.
Physiological response may explain why some severely obese patients overeat
Don't feel like you are getting full when eating a large meal? New research from The Miriam Hospital suggests that a physiological response may partially explain why severely obese individuals may not feel satisfied after eating and often have difficulty controlling the amount of food they consume during a meal.
Waiting times too long for bariatric surgery
Obesity is now acknowledged as a chronic disease with a number of related complications, and its prevalence has reached alarming epidemic proportions.
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