Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004

Abstract

Background: Bariatric surgery has emerged as the most effective treatment for class III obesity (body mass index, Ն40). The number of operations continues to increase. We measured case fatality and death rates by time since operation, sex, age, specific causes of death, and mortality rates. Design and Setting: Data on all bariatric operations performed on Pennsylvania residents between January 1, 1995, and December 31, 2004, were obtained from the Pennsylvania Health Care Cost and Containment Council. Matching mortality data were obtained from the Division of Vital Records, Pennsylvania State Department of Health. Outcome Measures: Age-and sex-specific death rates after bariatric surgery. Results: There were 440 deaths after 16 683 operations (2.6%). Age-specific death rates were much higher in men than in women and increased with age. Age-and sexspecific death rates after bariatric surgery were substantially higher than comparable rates for the age-and sexmatched Pennsylvania population. The 1-year case fatality rate was approximately 1% and nearly 6% at 5 years. Less than 1% of deaths occurred within the first 30 days. Fatality increased substantially with age (especially among those Ͼ65 years), with little evidence of change over time. Coronary heart disease was the leading cause of death overall, being cited as the cause of death in 76 patients (19.2%). Therapeutic complications accounted for 38 of 150 natural deaths within the first 30 days, including pulmonary embolism in 31 (20.7%), coronary heart disease in 26 (17.3%), and sepsis in 17 (11.3%). Conclusions: There was a substantial excess of deaths owing to suicide and coronary heart disease. Careful monitoring of bariatric surgical procedures and more intense follow-up could likely reduce the long-term case fatality rate in this patient population.

Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis

“…Unfortunately, causes of death were not consistently reported in included studies; only Overby et al [12] reported one out of three deaths related to PE. It has been reported that some unexplained deaths after bariatric surgery may be related to undiagnosed PE [1,12,14,16] , so this can be a cause of death that should be explored.…”

“…However, pulmonary embolism (PE) remains the second leading cause of perioperative mortality after anastomotic leak, accounting for almost 40% of perioperative deaths after bariatric surgery [1] . Lack of randomized controlled trials to guide thromboprophylaxis after bariatric surgery makes clinical decision making difficult among patients considered as high risk for VTE.…”

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

“…Após o bypass gástrico, os pacientes desenvolvem maior vulnerabilidade aos seus efeitos (rápida absorção e níveis séricos mais elevados) 86 , o que teoricamente os torna mais suscetíveis tanto às propriedades sistêmicas lesivas quanto aos efeitos psicotrópicos associados com acidentes por imprudência/impulsividade, sintomas depressivos e suicídio. Como visto anteriormente, de fato há maior incidência de mortes por abuso de substâncias (especialmente álcool) e acidentes automobilísticos nas grandes casuísticas com seguimento de pacientes bariátricos 3,4,24,87,88 .…”

“…Além disso, houve mais 14 óbitos relacionados com alcoolismo, bulimia e acidentes de trânsito, condições comumente associadas com comportamento impulsivo. De modo semelhante, Omalu et al 4 observaram aumento substancial no número de suicídios entre 16.683 pacientes bariátricos comparados à média da população em um perío-do de 10 anos. Além disso, os autores avaliam que a taxa de suicídio (16 casos) tenha sido subestimada porque os óbitos por overdose (14 casos) foram excluídos.…”

“…Além disso, os autores avaliam que a taxa de suicídio (16 casos) tenha sido subestimada porque os óbitos por overdose (14 casos) foram excluídos. A maioria dos casos de suicídio ocorreu após um ano da intervenção 4,5 .…”