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Cited by 41Bariatric Surgery and OutcomesBody Contouring and SurgeryMinimally Invasive Surgical Techniques

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

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Courcoulas, Anita P., Johnson, Eric, Arterburn, David E., Haneuse, Sebastien, Herrinton, Lisa J., Fisher, David P., Li, Robert A., Theis, Mary Kay +11 more·2023·Annals of Surgery
DOI 10.1097/sla.0000000000005155PMC PMC8840990
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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/m 2 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.

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  • For people with obesity and a BMI ≥35 kg/m2, bariatric surgery is often the most efficacious treatment for achieving and maintaining desired weight loss associated with improvements in health and quality of life.

    “For people who are living with obesity and have a body mass index (BMI) ≥35 kg/m2, 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).”

    From Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery (2022) · cites this paper as [1]

    The Methods (Surgical Patients; page unavailable) specify adults with BMI ≥35 kg/m², and the Discussion (page unavailable) says bariatric surgery produces durable weight loss and improvements in obesity-related conditions. The paper does not establish that it is the most efficacious treatment or address quality-of-life improvements. (LLM, conf=0.87)

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  1. [22]Harrell FE. Regression Modeling Strategies. Secaucus, NJ: Springer-Verlag New York, Inc.; 2006.
  2. [23]Kalbfleisch John D., and Prentice Ross L.. The Statistical Analysis of Failure Time Data. Vol. 360. John Wiley & Sons, 2011.

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Authors
Courcoulas, A. P., Johnson, E., Arterburn, D. E., Haneuse, S., Herrinton, L. J., Fisher, D. P., Li, R. A., Theis, M. K., Liu, L., Taylor, B., Cooper, J., Chin, P. L., Grinberg, G. G., Gupta, A., Saurabh, S., Um, S. S., Yenumula, P. R., Zelada, J. L., & Coleman, K. J.
Affiliations
  • University of Pittsburgh Medical Center (US)
  • Kaiser Permanente (US)
  • Harvard University (US)
  • Kaiser Permanente Northern California (US)
  • Kaiser Permanente Southern California, Pasadena, CA.
Corresponding author
Courcoulas, Anita P.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-08-13
Volume
277
Issue
3
Pages
442-448
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/sla.0000000000005155
PMC
PMC8840990
OpenAlex
W3188507394
Cited by
41
References
30
Citations by year
2026: 9 · 2025: 6 · 2024: 4 · 2023: 12 · 2022: 9 · 2021: 1
FWCI
6.10
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK105960)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
Keywords
bariatric surgery, sleeve gastrectomy, Roux-en-Y gastric bypass, morbid obesity, all-cause mortality, cardiovascular mortality, cancer mortality, diabetes mortality, matched cohort, long-term outcomes, COVID-19 pandemic, health care utilization, comorbidities, integrated health system, racial and ethnic disparities
MeSH terms
COVID-19, Gastrectomy, Humans, Obesity, Morbid, Retrospective Studies, Cohort Studies, Gastric Bypass

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