Abstract
Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18–60 years, BMI ≥ 40 kg/m2) admitted during 2002–2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27–0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68–0.88 and HR = 0.78; 0.63–0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.
Highlights
Obesity is a recognized prevalent disease associated with an increased risk for type 2 diabetes mellitus, cardiovascular, kidney, lung, and osteoarticular diseases, many cancers, and a reduced lifespan [1]
Between January 2002 and December 2018, a total of 2285 patients with severe obesity were enrolled in the IAI cohort
No other significant difference in the baseline characteristics was evident among types of bariatric surgery (BS)
Summary
Obesity is a recognized prevalent disease associated with an increased risk for type 2 diabetes mellitus, cardiovascular, kidney, lung, and osteoarticular diseases, many cancers, and a reduced lifespan [1]. The reduction in the risk of all-cause mortality by BS varied from 30 to 90% [2], with a 38% risk reduction being reported by a large meta-analysis of non-randomized comparative studies based upon registry data [3]. In patients with obesity, the rate of death for causes other than diseases, such as accidents or suicides, resulted in being higher after BS [5,6], and the relative risk of death remained higher than in the general background population, even after BS [4,6]. A large meta-analysis described a much more pronounced survival benefit in patients with diabetes mellitus, with a median
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