Risks and Benefits of Bariatric Surgery

Reported January 22, 2010

(Ivanhoe Newswire) -- A computerized model suggests that most morbidly obese individuals would likely live longer if they had gastric bypass surgery. However, the best decision for individual patients varies based on age, increasing body mass index and the effectiveness of surgery.

An estimated 5.1 percent of the U.S. population is morbidly obese, with a body mass index (BMI) of 40 or higher. Available evidence suggests that dietary, behavioral and pharmacologic treatments frequently fail to result in meaningful weight loss for individuals in this group. Bariatric surgery appears to be the only effective therapy for promoting clinically significant weight loss and improving obesity-related health conditions for the morbidly obese.

The procedure is not without risk, however, including in-hospital death.

Daniel P. Schauer, M.D., M.Sc., of the University of Cincinnati Academic Health Center, and colleagues used two nationally representative surveys and a recent large observational trial to construct a model estimating the benefits and risks of gastric bypass surgery. The model included data from almost 400,000 individuals nationwide to estimate the risk of death from obesity and its complications, data from 23,281 patients undergoing bariatric surgery to calculate in-hospital death rates, and outcomes from participants in a seven-year study to determine the effects of surgery on survival.

According to the resulting model, an average 42-year-old woman with a BMI of 45 would gain an estimated additional three years of life expectancy as a result of undergoing bariatric surgery. A 44-year-old man with the same BMI would gain an estimated 2.6 additional years.

Younger women with higher BMIs are projected to gain the most life expectancy from surgery. Younger men with higher BMIs might also gain more life expectancy after surgery, but the gain would be less for men than for women in each subgroup. "Younger patients have lower surgical risk and more time over which to realize the benefits of surgery," the authors were quoted as saying. "For older patients, the gain is smaller, and for some, gastric bypass surgery will decrease life expectancy."

"In conclusion,” they wrote, “. . . we believe results of this analysis can be used to better inform both patients' and physicians' decisions regarding gastric bypass surgery."

SOURCE: Archives of Surgery, January 2010