Medicare patients have a substantially higher risk of early death following bariatric surgery than previously suggested, and the risk of death is higher among men, older patients, and patients of surgeons who perform lower numbers of bariatric procedures, according to a study in the October 19 issue of JAMA: The Journal of the American Medical Association.
In the United States, most adults are overweight or obese, and obesity is soon to become the leading cause of death, according to background information in the article. Bariatric surgical procedures (surgery on the stomach and/or intestines designed to promote weight loss) are the only interventions that consistently help patients achieve significant and sustained weight loss and improvements with co-existing medical conditions. As a result, there has been dramatic growth in bariatric surgery over the last decade. Balanced against these beneficial effects, however, are the risks of perioperative death and short-term adverse outcomes, which have been poorly defined in the community at large.
David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to determine the risk of all-cause early postsurgical death among Medicare beneficiaries undergoing open bariatric surgery. The study examined early (30-day, 90-day, and 1-year) death figures for all U.S. fee-for-service Medicare beneficiaries who underwent bariatric procedures from 1997-2002.
A total of 16,155 patients underwent bariatric surgical procedures (average age, 48 years; 75.8 percent women, with 90.6 percent younger than 65 years). A total of 61.2 percent of cases were claims for the bariatric surgical procedure Roux-en-y gastroenterostomy (RYGB) and 19.9 percent were for RYGB with small intestine reconstruction to limit absorption. There was more than a 3-fold increase in the number of procedures performed from 1997 (n=1,464) to 2002 (n=4,814).
The researchers found that among all patients, the rates of 30-day, 90-day, and 1-year death were 2.0 percent, 2.8 percent, and 4.6 percent, respectively. Advancing age and male sex were associated with early death after bariatric surgery, with the highest rates of early death among older men. Overall, men were more likely to die after bariatric surgery than women (3.7 percent vs. 1.5 percent, 4.8 percent vs. 2.1 percent, and 7.5 percent vs. 3.7 percent for men and women at 30 days, 90 days, and 1 year, respectively). Death rates were greater for those aged 65 years or older (n=1,517) compared with younger patients (4.8 percent vs. 1.7 percent, 6.9 percent vs. 2.3 percent, and 11.1 percent vs. 3.9 percent at 30 days, 90 days, and 1 year, respectively).