After Bariatric Surgery class III obesity: Death Rates & Causes of Death

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Death Rates and Causes of Death After Bariatric

Surgery for Pennsylvania Residents, 1995-2004.

Bennet I. Omalu, MD, MPH; Diane G. Ives, MPH; Alhaji

M. Buhari, MA, MSIE; L. Lindner, DO; Philip

R. Schauer, MD; Cyril H. Wecht, MD, JD; H.

Kuller, MD, DrPH. Arch Surg. 2007;142:923-928.

Background

Bariatric surgery has emerged as the most effective

treatment for class III obesity (BMI 40). The number

of operations continues to increase. We measured case

fatality & death rates by time since operation, sex,

age, specific causes of death, & mortality rates.

Design & Setting

Data on all bariatric operations performed on

Pennsylvania residents between January 1, 1995, &

December 31, 2004, were obtained from the Pennsylvania

Health Care Cost & Containment Council. Matching

mortality data were obtained from the Division of

Vital Records, Pennsylvania State Dept of Health.

Outcome Measures

Age- & sex-specific death rates after bariatric

surgery.

Results

There were 440 deaths after 16 683 operations

(2.6%). Age-specific death rates were much higher in

men than in women & increased with age. Age- &

sex-specific death rates after bariatric surgery were

substantially higher than comparable rates for the

age- & sex-matched Pennsylvania population. The 1-year

case fatality rate was approx 1% & nearly 6% at 5

years. Less than 1% of deaths occurred within the

first 30 days. Fatality increased substantially with

age (especially among those > 65 years), with little

evidence of change over time. Coronary heart disease

was the leading cause of death overall, being cited as

the cause of death in 76 patients (19.2%). Therapeutic

complications accounted for 38 of 150 natural deaths

within the first 30 days, including pulmonary embolism

in 31 (20.7%), coronary heart disease in 26 (17.3%), &

sepsis in 17 (11.3%).

Conclusions

There was a SUBSTANTIAL EXCESS OF DEATHS owing to

SUICIDE & coronary heart disease. Careful monitoring

of bariatric surgical procedures & more intense

follow-up could likely reduce the long-term case

fatality rate in this patient population.

Author Affiliations: Dept of Epidemiology, University

of Pittsburgh (Drs Omalu, Wecht, and Kuller; Ms Ives;

and Mr Buhari), and Dept of Pathology, Allegheny

General Hospital (Dr Lindner), Pittsburgh,

Pennsylvania; and Dept of Surgery, The Cleveland

Clinic, Cleveland, Ohio (Dr Schauer).

http://archsurg.ama-assn.org/cgi/content/abstract/142/10/923

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