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Bariatric Surgery Risks Might Be Higher Than Previously Thought

New population-based data allow a more accurate assessment of risk for mortality and subsequent hospitalization.

Previous research has reported a low risk (about 0.5%) for perioperative and short-term mortality associated with bariatric surgery (primarily Roux-en-Y gastric bypass [RYGB]), but longer-term and population-based data are scant. Two new retrospective studies address this issue.

In one study, researchers used Medicare claims to assess mortality rates in 16,155 patients (mean age, 48; 76% women) who underwent bariatric surgery, mostly RYGB, from 1997 through 2002. The annual number of procedures increased from about 1400 to nearly 5000 during the study. Mortality rates at 30 days, 90 days, and 1 year were 2.0%, 2.8%, and 4.6%, respectively. Mortality was roughly twice as high in men as in women at all time points, and several times higher in patients 65 and older than in those younger than 65. Mortality was correlated strongly with comorbidity.

In another study, investigators assessed 60,077 patients (mean age, 42; 84% women) who underwent RYGB in California from 1995 to 2004. Perioperative mortality was 0.18%; 30-day and 1-year mortality rates were 0.33% and 0.91%, respectively. Hospitalization rates were about 8% in the year before surgery and 19% in the year after surgery; almost all hospitalizations before surgery were related to complications of obesity, and those after surgery were related to complications of the procedures or to other elective surgery (e.g., knee arthroplasty, or plastic surgery procedures).

Comment: These population-based data allow a more accurate assessment of risk for mortality and subsequent hospitalization in patients who are considering bariatric surgery. The mortality rates in the first study were exceptionally high, compared with those in the second study and those reported previously, presumably due to substantial levels of comorbidity that led to Medicare disability. The high rate of postsurgical hospitalization in the second study reflects a more realistic assessment of potential complications, second procedures, and revisions than has been reported previously.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine October 28, 2005

Citation(s):

Flum DR et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005 Oct 19; 294:1903-8.

• Original article (Subscription may be required)
• Medline abstract (Free)

Zingmond DS et al. Hospitalization before and after gastric bypass surgery. JAMA 2005 Oct 19; 294:1918-24.

• Original article (Subscription may be required)
• Medline abstract (Free)