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Medicineworld.org: Bariatric surgery among older

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Bariatric surgery among older




The use of bariatric surgery among older, severely obese patients was not linked to a decreased risk of death, as per a research studyin the June 15 issue of JAMA This study is being released early online to coincide with its presentation at the AcademyHealth Annual Research Meeting.



Bariatric surgery among older

"Obesity incidence has stabilized after decades of rapid increases, whereas the prevalence of patients with a body mass index [BMI] greater than 35 increased 39 percent between 2000 and 2005, the prevalence of severe obesity (BMI greater than 40) increased 50 percent, and the prevalence of superobesity (BMI greater than 50) increased 75 percent. Obesity is difficult to treat, and bariatric surgery is the most effective means to induce weight loss for the severely obese. Consequently, obesity surgery rates rapidly increased in tandem," as per background information in the article. "To date, no study to our knowledge has examined the long-term survival of high-risk patients who underwent bariatric surgery".

Matthew L. Maciejewski, Ph.D., of the Durham VA Medical Center, Durham, N.C., and his colleagues conducted a study to determine whether bariatric surgery is linked to reduced mortality among predominantly older male high-risk patients at Veterans Affairs medical centers. Mortality was examined for 850 veterans who had bariatric surgery in January 2000 to December 2006 (average age 49.5 years; average BMI, 47.4) and 41,244 nonsurgical controls (average age 54.7 years; average BMI 42.0) from the same 12 Veteran Integrated Service Networks; the follow-up was through December 2008.

Eleven of 850 surgical case patients (1.29 percent) died within 30 days of surgery. The surgical case patients had lower crude mortality rates than the nonsurgical controls (at 1 year, 1.5 percent vs. 2.2 percent; at 2 years, 2.2 percent vs. 4.6 percent; at 6 years, 6.8 percent vs. 15.2 percent ). In unadjusted analysis, bariatric surgery was linked to reduced mortality. However, in further analysis that included 1,694 propensity-matched patients (using a statistical approach to compare patients who appear to be "similar" in a number of ways, except for one of the matched patients having had the operation), bariatric surgery was not significantly linked to reduced mortality.

"Our results highlight the importance of statistical adjustment and careful selection of surgical and nonsurgical cohorts, especially during assessment of bariatric surgery as per administrative data. Prior studies claiming a survival benefit for bariatric surgery had limited clinical information to conduct detailed risk adjustment or matching. The survival differences between the bariatric surgery and control groups were modest in most prior studies, so the beneficial effects of surgery may have been attenuated if adjustment for confounders had been possible. We demonstrated that risk adjustment with regression analysis resulted in a significant association of surgery and survival that was reduced when equivalence in baseline characteristics improved via propensity matching in this high-risk patient group," the authors write.

The scientists add that even though bariatric surgery is not linked to reduced mortality among older male patients, a number of patients may still choose to undergo bariatric surgery, given the good evidence for significant reductions in body weight and co-existing illnesses and improved quality of life.

The body mass index or BMI, is a heuristic proxy for human body fat based on an individual's weight and height. You can find out your BMI by using an online BMI calculator.

Posted by: JoAnn    Source




Did you know?
The use of bariatric surgery among older, severely obese patients was not linked to a decreased risk of death, as per a research studyin the June 15 issue of JAMA This study is being released early online to coincide with its presentation at the AcademyHealth Annual Research Meeting.

Medicineworld.org: Bariatric surgery among older

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