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Surg Obes Relat Dis. 2015 Mar-Apr;11(2):399-405. doi: 10.1016/j.soard.2014.08.015. Epub 2014 Sep 6.

Causes and risk factors for mortality within 1 year after obesity surgery in a population-based cohort study.

Author information

1
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: wenjing.tao@ki.se.
2
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section for Upper Gastrointestinal Surgery, Department of General Surgery, South Hospital, Stockholm, Sweden.
3
Colorectal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom.
4
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
5
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, United Kingdom.

Abstract

BACKGROUND:

The use of obesity surgery has increased during the past decade. There is a need for population-based assessments of causes and risk factors for postoperative mortality. The objective of this study was to assess causes and risk factors for 1-year mortality after obesity surgery.

METHODS:

This nationwide retrospective population-based cohort study included essentially all obesity surgery patients in Sweden from 1980-2010. Data were collected from Swedish national registries and medical records. Patient characteristics, co-morbidities, and surgical procedures were assessed in relation to 1-year mortality through multivariable Cox proportional hazards regression, providing hazard ratios (HR), and 95% confidence intervals (CI) adjusted for age, sex, surgical procedure, surgical access, and co-morbidity.

RESULTS:

Among 22,487 obesity surgery patients the 1-year cumulative mortality was .38% (n = 85). Follow-up of cohort was complete. Median time of postoperative death was 45 days. Main causes of death included cardiopulmonary complications (myocardial infarction [n = 14; 16%], pulmonary embolism [n = 12; 14%], sudden cardiac arrest [n = 11; 13%]), and anastomotic leak (n = 12; 14%). Male sex (HR = 2.31; 95% CI 1.48-3.60), diabetes (HR = 2.47; 95% CI 1.44-4.23), and congestive heart failure (HR = 4.82; 95% CI 2.25-10.35) were independently associated with increased 1-year mortality, while age, hypertension, cerebrovascular disease, coronary heart disease, chronic obstructive pulmonary disease, asthma, and surgical procedure were not. Open surgery entailed an increased mortality compared to laparoscopic surgery from 2000-2010 (HR = 2.72; 95% CI 1.53-4.83), but not from 1990-1999 (HR = .39; 95% CI .11-1.32).

CONCLUSION:

Although the absolute risk of mortality is low, the increased relative risk of mortality associated with male sex, diabetes, congestive heart failure, and open surgical access could influence clinical decision making.

KEYWORDS:

Bariatric surgery; Epidemiology; Metabolic surgery; Postoperative complications; Short-term mortality; Treatment outcomes

PMID:
25604834
DOI:
10.1016/j.soard.2014.08.015
[Indexed for MEDLINE]

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