Weight loss surgery may raise life expectancy | Latest news for Doctors, Nurses and Pharmacists
For obese people, bariatric surgery can prevent premature death and increase the chances of living a long life.
In a large, 40-year retrospective study, people who had bariatric surgery were 16 percent less likely to die from any cause during a 40-year follow-up period (mean, 13.2 years) compared with people who didn't have the procedure (hazard ratio [HR]0.84, 95% confidence interval [CI]0.79–0.90; p<0.001). [Obesity 2023;doi:10.1002/oby.23646]
Diabetes-related deaths fell sharply by 72 percent, reported lead study author Dr. Ted Adams of the University of Utah School of Medicine in Salt Lake City, Utah, USA.
Deaths from cancer and cardiovascular disease also fell by 43 percent and 29 percent, respectively, he added.
Notably, Adams and his team estimated that obese patients who underwent bariatric surgery were expected to live 1.3 years longer after all-cause death (95% CI, 0.93–1.67; p<0.001).
The study included 21,837 matched obese participants (mean age 42 years, 79% female, mean baseline body mass index 46 kg/m2) with and without bariatric surgery. The most common procedure was Roux-en-Y gastric bypass (n=15,110; 69.2%), followed by gastric sleeve (n=3,050; 14.0%), adjustable gastric banding (n=2,629; 12.0%) ) and duodenal switch (n=1,048; 4.8%).
After more than 40 years of follow-up (median 10.8 years), 2,943 participants (13.5%) in the surgery group and 3,181 participants (14.6%) in the non-surgery group died.
Minimal but meaningful gain
The results of this study are consistent with those of the Swedish Obese Subjects (SOS) Study, in which bariatric surgery was associated with a 23% lower risk of mortality (HR, 0.77, 95% CI, 0.68–0.87; p<0.001 ) Median follow-up Time is 20-24 years. This represented an increase in median life expectancy of 2.4 years (95% CI, 1.2–3.5; p<0.001). [N Engl J Med 2020;383:1535-1543;
N Engl J Med 2007;357:741-752]
“This reduction in mortality is similar to our study,” Adams noted, adding, “When considering a population at increased clinical risk, such as severely obese patients, the smallest increase in mean life expectancy (i.e., 1.3 years) was meaningful.
“Even though the benefit on overall mortality was minimal, studies have shown a significant improvement in quality of life after bariatric surgery,” he said. [N Engl J Med 2018;378:93-96]
Adams also pointed to other noteworthy findings from their study. For the most part, the life expectancy advantage of bariatric surgery did not vary by type of surgery. Compared with no surgery, sleeve gastrectomy halved the overall risk of death (HR, 0.49, 95% CI, 0.30–0.79; p=0.004), and gastric banding reduced the overall risk of death by 28% and 15% ( HR, 0.72, 95% CI, 0.55)–0.94; p=0.017) and gastric bypass (HR, 0.85, 95% CI, 0.79–0.91; p<0.001).
Furthermore, this benefit was observed for women (HR, 0.86, 95% CI, 0.80–0.93; p<0.001) and men (HR, 0.79, 95% CI, 0.69–0.90; p<0.001) and for individuals of all age groups ( Age 35-44: HR, 0.83, 95% CI, 0.73-0.94; Age 45-54: HR, 0.67, 95% CI, 0.59-0.76; Age 55-80: HR, 0.75, 95% CI, 0.65-0.85 ), except those aged 18-34.
One downside of bariatric surgery, Adams acknowledged, is the risk of suicide.
Suicide risk was 2.4-fold (95% CI, 1.57–3.68) higher (p<0.001) compared with participants who did not undergo bariatric surgery, especially among participants aged 18 to 34 at the time of the procedure.
Adams emphasized the need for more aggressive preoperative psychological screening and postoperative follow-up, especially in bariatric surgery patients representing the 18-34 age group.
“Due to the decades-long persistence of bariatric surgery in reducing deaths from all causes and deaths related to cardiovascular disease, cancer and diabetes [in] Severely obese participants”, the current data may not only prompt bariatric surgery in severely obese patients, but also further stimulate important research related to the discovery of physiological and biomolecular mechanisms of weight loss and reduced mortality similar to non-surgical treatment This was achieved through bariatric surgery, according to the authors.