Overall and cause-specific mortality after Roux-en-Y gastric bypass surgery: A nationwide cohort study

Abstract

BackgroundFew population-based studies provide data on mortality after bariatric surgery. We hypothesized that hypoglycemia could be an underdiagnosed cause of death. ObjectivesTo examine perioperative, all-cause, and cause-specific long-term mortality in Roux-en-Y gastric bypass (RYGB) patients versus population comparisons. SettingDanish nationwide population-based cohort study. MethodsWe included all 9895 patients who underwent RYGB during 2006–2010, and a 1:25 age- and gender-matched comparison cohort (n = 247,366) (0.3% lost to follow up). We compared mortality rates and computed mortality rate ratios (MRR) for all-cause and cause-specific mortality using Cox regression analysis. For deceased RYGB patients (n = 91), we conducted a detailed medical record audit. ResultsThe perioperative (30-days) mortality after RYGB was .04% (4/9895). After 4.2 years, RYGB-related mortality (deaths due to intestinal obstruction/intra-abdominal leakage) was .15% (16/9895). All-cause mortality was very similar in the 2 cohorts (median age, 40.2 years; 21.7% men): RYGB cohort, .89% (n = 91); comparison cohort, .92% (n = 2204); MRR = 1.03 (95% confidence interval [CI], .84–1.27). Mortality due to suicide (2.78; 95% CI, 1.44–5.33), accidents (2.29; 95% CI, 1.16–4.54), gastrointestinal diseases (2.01; 95% CI, 1.06–3.84), and infectious diseases (1.75; 95% CI, .98–3.17) was higher in the RYGB cohort versus comparison groups, but mortality from cancer was lower (0.43; 95% CI, .27–.70). Our medical record audit indicated that 8% of deaths after RYGB (n = 7) were possibly hypoglycemia related. ConclusionPerioperative mortality after RYGB is low in Denmark, and subsequent all-cause mortality is similar to that of matched comparisons. After RYGB, patients have substantially increased mortality due to external causes such as suicide, accidents, and possibly hypoglycemia.