Mortality rate after open Roux-in-Y gastric bypass: a 10-year follow-up

Abstract

The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m2. The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m2, and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m2, and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.

Does the Attention Deficit Hyperactivity Disorder interfere with bariatric surgery results?

“…It is known that individuals with ADHD have a higher mean BMI and even less weight loss with clinical obesity treatment 17 . Concurrently, the higher the BMI, the greater the surgical morbidity and mortality 32 . Thus, it is expected that the treatment of such patients since the preoperative period allows better weight loss before the procedure and provides reduction of surgical complications.…”

Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know?

“…Over the last decade, numerous studies have reported an increase in mortality due to accident, drug overdose, and suicide among bariatric patients compared to the general population or obese individuals who have not undergone weight loss surgery (Pories et al 1995;Omalu et al 2005;Sjostrom et al 2013;Bruschi Kelles et al 2014). In recent years, an increasing number of studies have revealed a consistent, longitudinal, and positive association between obesity and symptoms of depression (Mather et al 2009;Luppino et al 2010;Faith et al 2011).…”

“…Building on this observational foundation laid by Adams et al (2007) and others (Pories et al 1995;Omalu et al 2005;Sjostrom et al 2013;Bruschi Kelles et al 2014), the first study of note to specifically investigate post-surgical suicidality was conducted by Tindle et al (2010) among Pennsylvanian residents. Apart from the overall elevated suicide rate of 6.6 per 10,000 person-years, which was approximately twice that reported by Adams et al (2007), the rates differed greatly between men and women (13.7/10,000 in men and 5.2/10,000 in women).…”

Both high fat and high carbohydrate diets impair vagus nerve signaling of satiety

“…Gastric banding has the lowest mortality rate (0.1%) but highest long-term failure rate (> 50%) 11 . Roux-en-Y gastric bypass, biliopancreatic diversion, and sleeve gastrectomy have lower failure rates but higher mortality rates [11][12][13] . These techniques increase stomach wall stretch which contributes to a feeling of fullness with less food.…”