Mortality after bariatric surgery ‘remarkably worse’ for men than women
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A significantly higher mortality rate was observed for men compared with women, both short term and long term, after bariatric surgery, according to a speaker at the European Association for the Study of Diabetes virtual meeting.
In an analysis of data from Austria, men were slightly older than women when they underwent bariatric surgery, which may contribute somewhat to the higher mortality rate, according to Hannes Beiglböck, MD, a PhD candidate in the division of endocrinology and metabolism at the Medical University of Vienna.
“It remains to be elucidated if earlier bariatric surgery in men could improve mortality outcomes,” Beiglböck told Healio. “Furthermore, awareness must be created especially in men to undergo bariatric surgery before several comorbidities have occurred.”
Researchers analyzed data on 19,901 people who underwent bariatric surgery in Austria from 2010 to 2018 (74% women). Data obtained from Austrian health insurance included reimbursed drug prescriptions, medical diagnoses and medical procedures. Comorbidities, including diabetes, cardiovascular disease, psychiatric disorders and malignancies, were analyzed for people who died after bariatric surgery. The study cohort was followed from 1 year prior to surgery until April 2020.
The study cohort had a mean age of 40.6 years, with men slightly older than women (mean age, 41.8 years vs. 40.1 years). During the observational period, 1.8% of patients died.
The mortality rate for bariatric surgery per year of observation was 0.34%. Men had a mortality rate per year of observation about 2.7 times higher than women (0.64% vs. 0.24%; P < .001). The overall mortality rate 30 days after bariatric surgery was 0.19%, with men having a significantly higher rate than women (0.48% vs. 0.08%; P < .001).
“It was already known that women are the majority of bariatric surgery candidates,” Beiglböck said. “Some studies showed that men tend to be older at the time of the operation. In our analysis, despite a higher rate of revision operation in women, mortality outcomes were remarkably worse in men. However, this considerable difference in short-term mortality and long-term mortality between men and women was not expected.”
The most common comorbidities in people who died were cardiovascular, observed in 48% of the study cohort, including 53% of men and 44% of women. Psychiatric disorders were reported in 47% of those who died, including 44% of men and 50% of women. Diabetes was observed in 36% of the people who died after surgery and malignant disease was reported in 33%.
Beiglböck said the study is lacking data on metabolic health and lifestyle, and future prospective studies with these data included could provide more detailed insight on sex disparities after bariatric surgery. However, he said, the findings reveal a need for men to consider undergoing bariatric surgery at a younger age.
“Preoperative counseling in men is of major importance,” Beiglböck said. “Moreover, potential barriers in men to undergo surgery earlier should be analyzed. Special awareness campaigns for men should be performed to motivate men to undergo bariatric surgery earlier.”
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Beiglböck H, et al. Oral presentation 72. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 27-Oct. 1, 2021 (virtual meeting).
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