Originally published in Insidermedicine
A new model that takes into account the risks of surgery, the risks of obesity, and the efficacy of bariatric surgery helps clarify which patients are likely to live longer as a result of this intervention. The research is published in the January issue of the Archives of Surgery.
• Consider it for patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions
• A doctor–patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gall bladder disease, and malabsorption.
• Refer patients to high-volume centers with surgeons experienced in bariatric surgery.
Researchers out of the University of Cincinnati Academic Health Center used data from the 2005 National Inpatient Survey to calculate in-hospital mortality risk associated with bariatric surgery. They calculated the excess risk of mortality associated with obesity using the 1991-1996 National Health Interview Survey linked to the National Death Index, and estimated the efficacy of bariatric surgery for weight loss based on a recent large observational trial.
Based on their model, a 42-year old woman with a body mass index (BMI) of 45 would gain an additional 2.95 years of life expectancy through bariatric surgery. Bariatric surgery had a baseline 30-day mortality of 0.2% and a baseline efficacy for reducing mortality of 53%. Surgery was no longer considered beneficial when surgical 30-day mortality exceeded 9.5% or when the efficacy of bariatric surgery for reducing mortality was decreased to 2% or less.
Today’s research provides a tool to help clinicians determine which of their obese patients will obtain a mortality benefit from bariatric surgery.