Even More Evidence to Support Lower Mortality After Metabolic Surgery

Anyone following the literature should by now have noticed the steady stream of evidence consistently showing reductions in morbidity and mortality following metabolic surgery.

Now, yet another study, this one by Anita Courcoulas and colleagues, published in the Annals of Surgery, provides further evidence for this. 

Their retrospective analyses included a cohort of patients who underwent sleeve gastrectomy (SG, n=13,900) or Roux-en-Y gastric bypass (RYGB, n=17,258)  from January 2005 to September 2015 in three integrated health systems in the US, that were matched to 87,965 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. 

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; SG: HR = 0.28). Similarly, RYGB was associated with a significantly lower 5-year risk of cardiovascular- (HR = 0.27), cancer- (HR = 0.54), and diabetes-related mortality (HR = 0.23). 

For patients with SG, there was not enough follow-up time to assess 5-year cause-specific mortality, but at 3-years follow-up, there was significantly lower risk of cardiovascular- (HR = 0.33), cancer- (HR = 0.26), and diabetes-related (HR = 0.15) mortality.

These findings are clearly consistent with the growing body of evidence that metabolic surgery, despite involving rather complex surgery, can very significantly reduce morbidity and mortality in individuals with severe obesity.

Not that I expect these data to convince the nay-sayers and sceptics – but for those of us who regularly counsel patients considering metabolic surgery, they do continue to raise our level of confidence in the substantial benefits of these procedures. 

Berlin, D