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Setarehdan SA, Mokhber S, Sheidaei A, Abdolhosseini MR, Pazouki A, Solaymani-Dodaran M. Comparative Analysis of Mortality Rates among Morbidly Obese Individuals: A Study of Patients Undergoing Bariatric Surgery, Nonsurgical Morbidly Obese Individuals, and the General Population. Obes Facts 2024:1-9. [PMID: 38657591 DOI: 10.1159/000538968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Mortality decreases following bariatric surgery. We explored the extent of the reduction and whether or not it reaches the general population level in a large cohort of patients with obesity. This study aimed to compare all-cause mortality between patients with obesity who undergo bariatric surgery and those who do not, with the general Iranian population during the same period. METHOD Data from Iran's National Obesity Surgery Database were used to establish a large cohort of patients registered between 2009 and 2019. The current vital status of the patients was determined by utilizing post-surgery follow-up data for those who underwent the operation. For patients without a surgery record, a predefined checklist was filled out through telephone interviews. Death data from the National General Registrar's office were obtained for all cohort members. RESULTS Of 13,313 cohort members, 12,915 were eligible for analysis. The median age at the first visit was 38 years, and 78% were women. 6,190 patients (47.9%) underwent bariatric surgery, and 6,725 patients (52.1%) were not yet operated on at the time of analysis. We observed 139 deaths during 53,880 person-years follow-ups. The median follow-ups for operated-on and not operated-on groups were 4 and 4.8 years. The mortality rates among nonoperated patients were 2.89 times higher (standardized mortality ratio [SMR] = 2.89, 95% CI: 2.36-3.53) than those in the general population, while in operated patients, the mortality rate decreased to 1.82 as high (SMR = 1.82, 95% CI: 1.34-2.46). CONCLUSION The risk of death has been diminished in the operated-on group. It still remains considerably higher than the risk in the general population.
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Affiliation(s)
- Seyed Amin Setarehdan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran,
| | - Somayeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
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Adams TD, Meeks H, Fraser A, Davidson LE, Holmen J, Newman M, Ibele AR, Richards N, Hunt SC, Kim J. Long-term all-cause and cause-specific mortality for four bariatric surgery procedures. Obesity (Silver Spring) 2023; 31:574-585. [PMID: 36695060 PMCID: PMC9881843 DOI: 10.1002/oby.23646] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This retrospective study incorporated long-term mortality results after different bariatric surgery procedures and for multiple age at surgery groups. METHODS Participants with bariatric surgery (surgery) and without (non-surgery) were matched (1:1) for age, sex, BMI, and surgery date with a driver license application/renewal date. Mortality rates were compared by Cox regression, stratified by sex, surgery type, and age at surgery. RESULTS Participants included 21,837 matched surgery and non-surgery pairs. Follow-up was up to 40 years (mean [SD], 13.2 [9.5] years). All-cause mortality was 16% lower in surgery compared with non-surgery groups (hazard ratio, 0.84; 95% CI: 0.79-0.90; p < 0.001). Significantly lower mortality after bariatric surgery was observed for both females and males. Mortality after surgery versus non-surgery decreased significantly by 29%, 43%, and 72% for cardiovascular disease, cancer, and diabetes, respectively. The hazard ratio for suicide was 2.4 times higher in surgery compared with non-surgery participants (95% CI: 1.57-3.68; p < 0.001), primarily in participants with ages at surgery between 18 and 34 years. CONCLUSIONS Reduced all-cause mortality was durable for multiple decades, for multiple bariatric surgical procedures, for females and males, and for greater than age 34 years at surgery. Rate of death from suicide was significantly higher in surgery versus non-surgery participants only in the youngest age at surgery participants.
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Affiliation(s)
- Ted D. Adams
- Intermountain Surgical Specialties/Digestive Health Clinical Program, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, SLC, UT, USA
- Department of Nutrition and Integrative Physiology, University of Utah, SLC, UT, USA
| | - Huong Meeks
- Huntsman Cancer Institute, University of Utah, SLC, UT, USA
| | - Alison Fraser
- Huntsman Cancer Institute, University of Utah, SLC, UT, USA
| | - Lance E. Davidson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, SLC, UT, USA
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
| | - John Holmen
- Intermountain Biorepository, Intermountain Healthcare, SLC, UT, USA
| | - Michael Newman
- University of Utah Health, Data Science Services, SLC, UT, USA
| | - Anna R. Ibele
- Division of General Surgery, Department of Surgery, University of Utah School of Medicine, SLC, UT, USA
| | - Nathan Richards
- Intermountain Surgical Specialties/Digestive Health Clinical Program, Salt Lake City, UT, USA
| | - Steven C. Hunt
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, SLC, UT, USA
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Jaewhan Kim
- Department of Physical Therapy, College of Health, University of Utah, SLC, UT, USA
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Gehle DB, Pullatt RC, Elias PS. Gastrojejunocolic fistula: case report of a rare late complication of laparoscopic Roux-en-Y gastric bypass and review of the literature. Int J Surg Case Rep 2021; 84:106152. [PMID: 34280970 PMCID: PMC8274295 DOI: 10.1016/j.ijscr.2021.106152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) is known as the weight loss surgery to which other bariatric procedures are compared. While morbidity and mortality of this procedure are low, serious complications do exist which can be life-threatening and sometimes require surgical correction. Case presentation A 63-year-old woman underwent LRYGB outside of the United States, later complicated by biliary colic treated with cholecystectomy and upper gastrointestinal bleeding secondary to H. pylori-related ulcer at her gastrojejunostomy. Following adequate treatment of the patients marginal ulcer, the patient experienced several months of progressive severe abdominal pain, frequent vomiting and diarrhea, and unintentional weight loss refractory to pharmacologic therapy. The patient underwent multiple medical and endoscopic evaluations unrevealing of an organic cause of her symptoms. At presentation, the patient was found to be profoundly weak, dehydrated and malnourished with metabolic derangements and was subsequently diagnosed with a gastrojejunocolic fistula via upper endoscopy and radiography. We provided excluded stomach gastrostomy tube feeding to the patient for three months to improve the patients nutritional status before definitive surgical correction was successfully performed. Discussion Large bowel fistulas are a rare and highly morbid late complication following LRYGB and are likely secondary to marginal ulcers and/or instrumentation such as endoscopy. Surgery represents the definitive treatment. Conclusion LRYGB is typically a safe and effective intervention for obesity. Large bowel fistulas are rare complications following this surgery. We highlight difficulties in diagnosing and treating this condition. Morbidity and mortality of bariatric surgery have decreased since 1990s. Large bowel fistulas are a rare, highly morbid complication after gastric bypass. Important to optimize patient nutrition before correction of colonic fistulas
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Affiliation(s)
- Daniel B Gehle
- Medical University of South Carolina College of Medicine, 96 Jonathan Lucas Street, Suite 601, MSC 617, Charleston, SC 29425, USA
| | - Rana C Pullatt
- Medical University of South Carolina, Department of Surgery, Division of Gastrointestinal and Laparoscopic Surgery, 114 Doughty Street, Charleston, SC 29425, USA
| | - Puja S Elias
- Medical University of South Carolina, Department of Medicine, Division of Gastroenterology and Hepatology, 30 Courtenay Drive, Suite 249, MSC 702, Charleston, SC 29425, USA.
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Arnouk J, Rachakonda VP, Jaiyeola D, Behari J. Differential Outcomes and Clinical Challenges of NAFLD With Extreme Obesity. Hepatol Commun 2020; 4:1419-1429. [PMID: 33024913 PMCID: PMC7527693 DOI: 10.1002/hep4.1572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/17/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is closely associated with obesity. The prevalence of extreme obesity, defined as body mass index (BMI) of 50 kg/m2 or higher, is rising more rapidly than overall obesity. We aimed to compare the clinical outcomes and performance of noninvasive fibrosis assessment tools in NAFLD with or without extreme obesity. A retrospective analysis was performed in 304 patients with NAFLD with extreme obesity and compared them to patients with NAFLD with BMI of 40 kg/m2 or less, matched for age, gender, race, and liver fibrosis stage. The mean age of the NAFLD with extreme obesity cohort was 55.9 years, BMI 55 kg/m2, and 49.7% had cirrhosis at initial evaluation. Baseline cirrhosis and coronary artery disease were associated with increased risk of death, and dyslipidemia with decreased risk of mortality. Age, insulin use, hypertension, albumin and platelet count were associated with cirrhosis. Fifteen percent of patients had weight‐loss surgery, but this was not associated with survival or risk of cirrhosis. Of the 850 abdominal ultrasound scans performed in 255 patients, 24.1% were deemed suboptimal for hepatocellular carcinoma screening. The mean NAFLD fibrosis score (NFS) in the extreme obesity cohort, versus a propensity‐matched cohort with BMI of 40 kg/m2 or less, was significantly different for both low fibrosis (F0‐F2) (0.222 vs. −1.682, P < 0.0001) and high fibrosis (F3‐F4) (2.216 vs. 0.557, P < 0.001). Conclusion: NAFLD with extreme obesity is associated with increased risk of liver‐related and overall mortality. Accurate noninvasive assessment of liver fibrosis, low rates of weight loss surgery, and high failure rate of ultrasound were identified as clinical challenges in this population.
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Affiliation(s)
- Joud Arnouk
- Division of Gastroenterology, Hepatology and NutritionDepartment of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Vikrant P. Rachakonda
- Division of Gastroenterology, Hepatology and NutritionDepartment of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Diana Jaiyeola
- Division of Gastroenterology, Hepatology and NutritionDepartment of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
- St. Luke's University Health SystemBethlehemPA
| | - Jaideep Behari
- Division of Gastroenterology, Hepatology and NutritionDepartment of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
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