Journal Article

Long-term clinical outcomes of bariatric surgery in adults with severe obesity: A population-based retrospective cohort study

Wiebe, Natasha, Tonelli, Marcello

2024

Overview

Bariatric surgery leads to sustained weight loss in a majority of recipients, and also reduces fasting insulin levels and markers of inflammation. We described the long-term associations between bariatric surgery and clinical outcomes including 30 morbidities. We did a retrospective population-based cohort study of 304,157 adults with severe obesity, living in Alberta, Canada; 6,212 of whom had bariatric surgery. We modelled adjusted time to mortality, hospitalization, surgery and the adjusted incidence/prevalence of 30 new or ongoing morbidities after 5 years of follow-up. Over a median follow-up of 4.4 years (range 1 day-22.0 years), bariatric surgery was associated with increased risk of hospitalization (HR 1.46, 95% CI 1.41,1.51) and additional surgery (HR 1.42, 95% CI 1.32,1.52) but with a decreased risk of mortality (HR 0.76, 95% CI 0.64,0.91). After 5 years (median of 9.9 years), bariatric surgery was associated with a lower risk of severe chronic kidney disease (HR 0.45, 95% CI 0.27,0.75), coronary disease (HR 0.49, 95% CI 0.33,0.72), diabetes (HR 0.51, 95% CI 0.47,0.56), inflammatory bowel disease (HR 0.55, 95% CI 0.37,0.83), hypertension (HR 0.70, 95% CI 0.66,0.75), chronic pulmonary disease (HR 0.75, 95% CI 0.66,0.86), asthma (HR 0.79, 95% 0.65,0.96), cancer (HR 0.79, 95% CI 0.65,0.96), and chronic heart failure (HR 0.79, 95% CI 0.64,0.96). In contrast, after 5 years, bariatric surgery was associated with an increased risk of peptic ulcer (HR 1.99, 95% CI 1.32,3.01), alcohol misuse (HR 1.55, 95% CI 1.25,1.94), frailty (HR 1.28, 95% 1.11,1.46), severe constipation (HR 1.26, 95% CI 1.07,1.49), sleep disturbance (HR 1.21, 95% CI 1.08,1.35), depression (HR 1.18, 95% CI 1.10,1.27), and chronic pain (HR 1.12, 95% CI 1.04,1.20). Bariatric surgery was associated with lower risks of death and certain morbidities. However, bariatric surgery was also associated with increased risk of hospitalization and additional surgery, as well as certain other morbidities. Since values and preferences for these various benefits and harms may differ between individuals, this suggests that comprehensive counselling should be offered to patients considering bariatric surgery.

• Publisher: Public Library of Science
• Subject: Adult / Adults / Alberta - epidemiology / Alcoholism / Algorithms / Asthma / Bariatric Surgery - adverse effects / Cancer / Cardiovascular disease / Chronic illnesses / Chronic kidney failure / Chronic pain / Clinical outcomes / Cohort analysis / Comorbidity / Congestive heart failure / Constipation / Coronary heart disease / Coronary vessels / Dementia / Diabetes / Diabetes mellitus / Female / Follow-Up Studies / Gastrointestinal surgery / Heart diseases / Heart failure / Hospitalization / Humans / Hypertension / Inflammation / Inflammatory bowel diseases / Kidney diseases / Lung diseases / Male / Medicine and Health Sciences / Metastasis / Middle Aged / Mortality / Mortality risk / Obesity / Obesity, Morbid - complications / Obesity, Morbid - mortality / Obesity, Morbid - surgery / Osteoporosis / Patient outcomes / Peptic ulcer / Peptic ulcers / Population studies / Retrospective Studies / Risk / Schizophrenia / Sleep apnea / Surgery / Treatment Outcome / Ulcers / Vein & artery diseases / Weight control / Weight loss