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Obes Surg. 2019 Jul 5. doi: 10.1007/s11695-019-04055-4. [Epub ahead of print]

All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers.

Author information

1
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. ljrtorvik@northwestern.edu.
2
Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. ljrtorvik@northwestern.edu.
3
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
4
Department of Health Systems Management, Ariel University, Ariel, Israel.
5
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
6
Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
7
Internal Medicine Department D and EASO Collaborating Center for Obesity Management, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.
8
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
9
Department of Epidemiology, Ben Gurion University of the Negev, Beer Sheva, Israel.

Abstract

INTRODUCTION:

Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers.

MATERIALS AND METHODS:

We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders.

RESULTS:

There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54-2.56) and non-smoking (HR, 1.93; 95% CI, 1.12-3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction = .67).

CONCLUSIONS:

Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.

KEYWORDS:

Bariatric surgery; Gastric banding; Mortality; Roux-en-Y gastric bypass; Sleeve gastrectomy; Subgroups

PMID:
31278656
DOI:
10.1007/s11695-019-04055-4

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