Reduction in Long-term Mortality After Sleeve Gastrectomy and Gastric Bypass Compared to Nonsurgical Patients With Severe Obesity

Abstract

Objective: To separately compare the long-term risk of mortality among bariatric surgical patients undergoing either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) to large, matched, population-based cohorts of patients with severe obesity who did not undergo surgery. Background: Bariatric surgery has been associated with reduced long-term mortality compared to usual care for severe obesity which is particularly relevant in the COVID-19 era. Most prior studies involved the RYGB operation and there is less long-term data on the SG. Methods: In this retrospective, matched cohort study, patients with a body mass index ≥35 kg/m2 who underwent bariatric surgery from January 2005 to September 2015 in three integrated health systems in the United States were matched to nonsurgical patients on site, age, sex, body mass index, diabetes status, insulin use, race/ethnicity, combined Charlson/Elixhauser comorbidity score, and prior health care utilization, with follow-up through September 2015. Each procedure (RYGB, SG) was compared to its own control group and the two surgical procedures were not directly compared to each other. Multivariable-adjusted Cox regression analysis investigated time to all-cause mortality (primary outcome) comparing each of the bariatric procedures to usual care. Secondary outcomes separately examined the incidence of cardiovascular-related death, cancer related-death, and diabetes related-death. Results: Among 13,900 SG, 17,258 RYGB, and 87,965 nonsurgical patients, the 5-year follow-up rate was 70.9%, 72.0%, and 64.5%, respectively. RYGB and SG were each associated with a significantly lower risk of all-cause mortality compared to nonsurgical patients at 5-years of follow-up (RYGB: HR = 0.43; 95% CI: 0.35,0.54; SG: HR = 0.28; 95% CI: 0.13,0.57) Similarly, RYGB was associated with a significantly lower 5-year risk of cardiovascular-(HR = 0.27; 95% CI: 0.20, 0.37), cancer- (HR = 0.54; 95% CI: 0.39, 0.76), and diabetes-related mortality (HR = 0.23; 95% CI:0.15, 0.36). There was not enough follow-up time to assess 5-year cause-specific mortality in SG patients, but at 3-years follow-up, there was significantly lower risk of cardiovascular- (HR = 0.33; 95% CI:0.19, 0.58), cancer- (HR = 0.26; 95% CI:0.11, 0.59), and diabetes-related (HR = 0.15; 95% CI:0.04, 0.53) mortality for SG patients. Conclusion: This study confirms and extends prior findings of an association with better survival following bariatric surgery in RYGB patients compared to controls and separately demonstrates that the SG operation also appears to be associated with lower mortality compared to matched control patients with severe obesity that received usual care. These results help to inform the tradeoffs between long-term benefits and risks of bariatric surgery.

Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis

“…diabetic vs. non-diabetic, or Roux-en-Y gastric bypass (RYGB) vs. sleeve gastrectomy] and are thus mentioned twice in the forest plot. 49 , 54 , 65 Seven studies investigated CV mortality, with incidences of 0.2–8.3% in bariatric patients and 0.5–12.9% in controls. The results in the meta-analysis showed that bariatric surgery also reduced CV mortality (HR 0.59, 95% CI 0.47–0.73, P < 0.001, I 2 = 71%; see Supplementary material online , Figure S3 ).…”

Nutritional Management in Bariatric Surgery Patients

“…BS reduces 5 years of mortality [50], and, particularly RYGB decreases cardiovascular and renal risk [51], more significantly than the non-surgical treatment. However, above all, BS has been shown to be able in most cases to induce remission of type 2 diabetes, a chronic disease that increases mortality in obese patients, especially due to micro-and macrovascular complications.…”

Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery

“…For people who are living with obesity and have a body mass index (BMI) ≥35 kg/m 2 , bariatric surgery is often the most efficacious treatment for achieving and maintaining desired weight loss that is associated with improvements in health and quality of life ( 1 ). Unfortunately, providers and patients alike are often uneducated about the efficacy versus the risk of having bariatric surgery, and it remains an underutilized treatment for obesity ( 2 ).…”