Veterans classified as superobese and those with higher
chronic disease burden appear more likely to die within one year following
bariatric surgery, according to a new report in Archives of
Surgery.
The number of bariatric procedures performed in Veterans
Affairs medical facilities more than tripled from 2000 to 2006; however,
bariatric surgery is only performed on about 0.1% of all veterans who meet BMI
criteria, according to background information.
Researchers examined patient factors associated with
mortality among 856 obese veterans who underwent bariatric surgery in 12 VA
bariatric surgeries from 2000 to 2006. Patients were, on average, aged 54
years, had an average BMI of 48.7 and 73% were men.
During follow-up, 6.3% of patients died; 1.3% died 30
days after surgery, 2.1% died 90 days after surgery and 3.4% died after one
year.
Statistical models revealed that patients classified as
superobese, with a BMI ≥50 (36% of cohort), and those with a higher score on
a measure of costs related to co-occurring disease (8% of cohort) had an
increased risk for death.
Superobese patients accounted for 30 deaths in the
overall cohort. The death rate after 30 days was 2%, after 90 days was 3.6% and
after one year was 5.2%. Rates increased with higher comorbidity cost scores:
1.5% after 30 days; 5.8% after 90 days; 10.1% after one year.
The researchers cited several explanations for the
increased risk for death among superobese patients, including increased
difficulty of bariatric surgeries because of extra abdominal fat; greater risk
for wound complications and blood clotting; and more obesity-related illnesses.
“These findings suggest that the risks of bariatric
surgery in patients with significant comorbidities, such as congestive heart
failure, complicated diabetes and chronic obstructive pulmonary disease, should
be carefully weighed against potential benefits in older male patients and
those with superobesity,” the researchers wrote.
In an accompanying editorial, Clifford W. Deveney,
MD, from the department of surgery at Oregon Health and Sciences
University, Portland, acknowledged that there is a group of patients,
particularly older men with high morbidity scores, who may not see a survival
advantage following bariatric surgery.
“Despite seeing increased mortality up to one year
[in this study], others have demonstrated a clear survival benefit of bariatric
surgery during five to 10 years, with survival advantage beginning at six
months after surgery,” Deveney wrote. “Therefore, despite the fact
that the mortality rate increases during the postoperative period up to one
year, it is small and does not negate the several advantages for patients who
undergo bariatric surgery.” – by Katie Kalvaitis
Arterburn D. Arch Surg. 2009;144:914-920.
More In
the Journals summaries>>
