Gastric bypass improves survival for obese patients with and without diabetes

Patients with obesity who undergo gastric bypass surgery have better rates of long-term survival than those who do not opt for the procedure, according to research published in The American Journal of Surgery.

“There is a clear survival advantage for morbidly obese patients that pursue surgical therapy,” Peter T. Hallowell, MD, FACS, of the University of Virginia, told Endocrine Today. “This was true for non-diabetics as well as diabetics. Bariatric surgery is safe, effective and saves lives.”

Hallowell and colleagues compared 401 patients who had gastric bypass surgery at the University of Virginia in 2002 and 2003 with 401 propensity-matched patients who met the criteria for, but did not undergo, the procedure. 

The investigators collected long-term, all-cause mortality data and analyzed the information using Kaplan-Meier curves. Median follow-up time was similar between groups.

At 30 days or 1 year after gastric bypass surgery, no significant differences in survival rates were demonstrated between patients who had surgery and those who did not.  

Substantial improvements became clear beginning at 5 years, with a mortality rate of 2.2% for gastric bypass patients vs. 6.7% for controls (P = .003); at 10 years, the mortality rates were 5.4% and 11.5%, respectively (P = .002).

Overall, the likelihood of dying was lower for patients who had gastric bypass surgery compared with those who did not (OR = 0.48; 95% CI, 0.29-0.78).

The mortality rate improvements were similar for patients with diabetes who underwent the surgery compared with those who did not at 5 years (3.1% vs. 12.4 %; P = .01) and 10 years (10.2% vs. 19.4%; P = .04), with the odds of dying still lower with gastric bypass (OR = 0.49; 95% CI, 0.26-0.97).

Although this study focused only on gastric bypass surgery, other procedures should be studied, and particularly sleeve gastrectomy, Hallowell said.

“Physicians need to discuss with patients their options for treatment and the benefits surgery may provide. Policymakers and insurers need to recognize the benefit that surgery provides for patients who are morbidly obese and remove the barriers to this life-saving treatment,” he said. – by Allegra Tiver

For more information:

Peter T. Hallowell, MD, FACS, can be reached at the University of Virginia, Department of Surgery, PO Box 800709, Charlottesville, VA 22908; email: PTH2F@hscmail.mcc.virginia.edu