Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls

doi:10.1016/j.soard.2007.06.003

Surgery for Obesity and Related Diseases

Volume 3, Issue 5, September–October 2007, Pages 496-502

Presented at the Plenary Session of the 24th Annual Meeting of the American Society for Bariatric Surgery, San Diego, California, June 11–16, 2007.

https://doi.org/10.1016/j.soard.2007.06.003 Get rights and content

Abstract

Background

To compare the mortality rate of obese patients treated by laparoscopic gastric banding (LAGB) with the mortality rate of matched obese patients observed at medical centers. The net effect of bariatric surgery on total mortality is still controversial. Gastric bypass has been shown to reduce the relative risk of death, but similar data with LABG are still lacking.

Methods

The surgical series was composed of 821 patients with a body mass index (BMI) >40 kg/m² consecutively treated with LAGB at Padova University, Italy. The reference group was composed of 821 gender-, age-, and BMI-matched patients selected from a sample of 4681 adults with a BMI >40 kg/m² observed at 6 Italian medical centers not using surgical therapy.

Results

The mean follow-up was 5.6 ± 1.9 and 7.2 ± 1.2 years in the surgical and reference group, respectively. The vital status was known in 97.6% of the surgical group (8 deaths) and in 97.4% of the reference group (36 deaths). In the surgical group, the percentage of excess weight loss was 39.8% ± 17.9% 1 year after LAGB and 37.2% ± 23.8% 5 years after LAGB. The rate of late revisional surgery was 12.2%. Survival was estimated using the Kaplan-Meier method, and the differences between the 2 groups were evaluated using the log-rank test. The survival rate was significantly greater in the surgical group (P = 0.0004). On multivariate Cox analysis, the 5-year relative risk of death in the surgical group, adjusted for gender, age, and baseline BMI, was 0.36 (95% confidence interval 0.16–0.80).

Conclusion

LAGB was associated with a 0% operative mortality rate and 40% stable excess weight loss. LAGB patients had a 5-year 60% lower risk of death than comparable morbidly obese patients.

Section snippets

Patients and procedures

The bariatric surgery cohort was extracted from 1015 morbidly obese patients consecutively treated with LAGB at the Centre for Medical and Surgical Therapy of Obesity, University of Padova, Italy, from January 1994 to December 2001. The clinical protocol used in our institution for the selection of obese patients for surgery has been previously described [9]. Patients were selected according to the inclusion criteria standardized by the National Institutes of Health [4]: only patients with a

Results

The baseline characteristics of the bariatric surgery and reference cohorts are reported in Table 1. Despite the matching procedure, the reference cohort had a mean age that was significantly older than that of the surgical cohort, with no differences in the obesity level. In the bariatric surgery cohort, the prevalence of type 2 diabetes at baseline was 25.1%, the prevalence of hypertension was 38.5%, and the prevalence of dyslipidemia was 25.9%. Sleep apnea was diagnosed in 39.7% of patients

Discussion

In this study, we analyzed the total mortality in a large series of morbidly obese patients treated with LAGB at a single tertiary Italian surgical center, and we compared the 5-year death rate after surgery with the total mortality of a comparable group of morbidly obese patients observed in tertiary Italian obesity care centers not using bariatric surgery. In our experience, LAGB was safe and effective [12], with a low rate of long-term complications and a weight loss that was lower than the

Conclusion

The results of our follow-up study have shown a clear reduction of total mortality in morbidly obese patients treated with LAGB compared with age-, gender-, and BMI-matched obese controls seeking treatment at medical centers. The level of evidence produced by our study was well below the level of evidence of a prospective randomized trial. However, our observations are in agreement with the results of epidemiologic studies investigating the relationship between intentional weight loss and total

Disclosures

A detailed list of potential conflicts of interest for all authors follows: Luca Busetto is a consultant for Medtronic, a speaker for Abbott Laboratories, and has received travel expenses from Sanofi-Aventis; Franco Favretti is a consultant for Medtronic; and Giuliano Enzi has received a research grant and travel expenses from Sanofi-Aventis.

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Association of prior bariatric surgery with financial and clinical outcomes of acute myocardial infarction
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Superior clinical outcomes after hospitalization for cardiovascular-related disease such as acute heart failure have been linked with prior history of bariatric surgery, but similar analyses in acute myocardial infarction (MI) are currently limited.
This work examines clinical outcomes and resource utilization in patients with acute MI hospitalizations with a prior history of bariatric surgery.
Academic university-affiliated hospital in the United States.
All adult patients with hospitalizations with a primary diagnosis of acute MI were queried using the 2016–2020 Nationwide Readmissions Database. The study population was comprised of patients with an International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code for obesity (body mass index ≥35 kg/m²) as well as those with a prior history of bariatric surgery regardless of their body mass index status. Comparison was made between those with a prior history of bariatric surgery and those without. Univariate analysis and multivariate regression models were used to examine the association between bariatric surgery and outcomes of interest, which included in-hospital mortality, medical complications, and resource utilization.
Of an estimated 2,736,606 hospitalizations for acute MI, 296,902 patients (10.8%) had a diagnosis of obesity and/or a prior history of bariatric surgery. The bariatric cohort was more frequently female and had a lower prevalence of congestive heart failure, chronic lung disease, diabetes, and electrolyte derangements than the nonbariatric cohort. After risk adjustment, prior history of bariatric surgery was associated with significantly lower odds of in-hospital mortality, cardiogenic shock, and acute kidney injury. Additionally, prior history of bariatric surgery was linked to a decreased duration of hospital stay and lower hospitalization costs as well as lower odds of nonhome discharge.
Among acute MI patients with obesity, prior history of bariatric surgery was associated with decreased odds of in-hospital mortality, improved clinical outcomes, and lower resource utilization. Expansion of bariatric surgery programs may provide improved access to a medical intervention that is intertwined with cardiovascular health.
Impact of Bariatric Surgery on the Prevalence and Outcomes of Atrial Fibrillation in Obese Patients
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Obesity has been identified as a significant factor contributing to the development of numerous cardiovascular conditions and as a result, the cardiovascular community has prioritized efforts to address obesity and reduce its associated risks. However, despite these efforts, the prevalence of obesity continues to rise steadily, and is projected to double in the upcoming years. Atrial fibrillation is among the most prevalent and extensively researched cardiovascular comorbidities associated with obesity. Several mechanisms have been postulated, including scar tissue formation and fat deposition, which ultimately leads to atrial remodeling and subsequent arrhythmogenesis. Numerous strategies have been implemented to prevent and manage obesity, encompassing lifestyle adjustments, dietary modifications, pharmacological treatments, and surgical interventions. Bariatric surgery has garnered significant recognition over the years due to its promising outcomes, including a decrease in the overall prevalence of atrial fibrillation and other cardiovascular comorbidities in general in obese patients. This study focuses on the current trends regarding the impact of bariatric surgery on obese patients with atrial fibrillation.
Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants
2021, The Lancet
Citation Excerpt :
We also elected to exclude the study by Sheetz and colleagues38 because it focused exclusively on patients with pre-existing end-stage renal failure; we considered the characteristics of this extremely high-risk patient population and the interventions they received (such as a much higher rate of kidney transplant procedures) to be vastly different from all other studies, and decided that its inclusion would only render the pooled treatment effects difficult to interpret and generalise. In total, 17 articles were included, of which eight (coarsened exact) matched with user-specified bins,27,29,31,62–65 four used propensity-score matching,25,32,66–68 two employed sequential stratification matching,28,30 one matched on the Mahalanobis distance metric,26 one had greedy nearest neighbour matching,33 and one study was a prospective controlled trial24 that used sequential treatment assignment to create a contemporaneously-matched control group. Patient characteristics and intervention details are summarised in the appendix (pp 42–46).
Metabolic–bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy—especially stratified by pre-existing diabetes status—are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic–bariatric surgery versus usual care.
We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic–bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic–bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472.
Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic–bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3–51·9, p<0·0001) and median life expectancy was 6·1 years (95% CI 5·2–6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370–0·453, p<0·0001) or without (0·704, 0·588–0·843, p<0·0001) baseline diabetes who underwent metabolic–bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup I² 95·7%, p<0·0001). Median life expectancy was 9·3 years (95% CI 7·1–11·8) longer for patients with diabetes in the surgery group than the non-surgical group, whereas the life expectancy gain was 5·1 years (2·0–9·3) for patients without diabetes. The numbers needed to treat to prevent one additional death over a 10-year time frame were 8·4 (95% CI 7·8–9·1) for adults with diabetes and 29·8 (21·2–56·8) for those without diabetes. Treatment effects did not appear to differ between gastric bypass, banding, and sleeve gastrectomy (I² 3·4%, p=0·36). By leveraging the results of this meta-analysis and other published data, we estimated that every 1·0% increase in metabolic–bariatric surgery utilisation rates among the global pool of metabolic–bariatric candidates with and without diabetes could yield 5·1 million and 6·6 million potential life-years, respectively.
Among adults with obesity, metabolic–bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without.
None.
The role of bariatric surgery in normalization of the coagulation profiles
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Citation Excerpt :
There was no EWL percentage difference between patients who underwent LSG compared with RYGB (82.2% ± 29 versus 73.2 ± 21.7, P = .1). It has been shown that weight loss after bariatric surgery reduces mortality risk in the morbidly obese [1,2]. Included in the mortality risk, is an increased incidence of thromboembolic events.
Bariatric surgery achieves appropriate excess weight loss, controlling related co-morbidities, including coagulation abnormalities.
We investigated the change in the coagulation profile after postoperative weight stabilization, correlating between EWL ratio and change in the coagulation profile.
This study took place in our teaching institution (university setting).
Between the years 2012 and 2014, 67 patients underwent surgery; 47 patients underwent laparoscopic sleeve gastrectomy (SG) and 20 patients underwent Roux-en-Y gastric bypass (RYGB). Average follow-up of postoperative thromboelastography (TEG) parameters was 30 ± 10.8 months (12–77). Average body mass index (BMI) before surgery was 41.7 ± 4.6 $kg / m^{2}$ , average percentage of EWL at the time of data collection was 79%. Patients were divided into 3 groups, 6 patients had EWL < 50%, 13 had an EWL > 100%, and 48 had EWL between 50% and 100%. Exclusion criteria: use of anticoagulation, antiplatelet, or contraceptive medications; known thrombophilic, renal, hepatic, and hematologic diseases/disorders. Two follow-up groups: 1–2 years and over 2 years. Patients underwent pre and postoperative TEG coagulation studies, including maximal amplitude (MA), and clot strength (G).
Coagulation profile improved after bariatric surgery. Most prominent change seen in MA and G. There was a linear correlation between the EWL ratio and improvement of MA values starting at 50% EWL peaking at 60%-70%. There was no difference in the coagulation profile after surgery in the two surgery groups (SG and RYGB).
Achieving appropriate weight loss after bariatric surgery improves the coagulation profile as measured by TEG, probably decreasing thromboembolic risk in those patients. We recommend expanding the current indication for bariatric surgery to include patients with altered coagulation profile measured by TEG.
Exercise and apulian hypocaloric diet affect adipokine changes and gastric banding-induced weight loss: A prospective study on severe obese subjects
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Adiponectin and Resistin correlate with insulin sensitivity and cardiovascular risk, respectively. This study aimed to identify lifestyle factors that modulate changes in Adiponectin and Resistin levels after gastric banding positioning (LapGB).
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There is a significant lack of long-term data addressing the postbariatric surgery experience. While the mortality rate of severely obese individuals is higher than that of the general population, there are overall survival gains in subjects undergoing bariatric surgery. Operated individuals have lower rates of cancer and cardiovascular diseases, but such information has come from studies with poor methodological quality. As to violent deaths, the risk of suicide was twice that of the general population. The number of hospital admissions after bariatric surgery was higher compared to before surgery in all before-and-after studies. Quality of life (QoL) assessments after bariatric surgery are directly correlated with weight loss, followed by gradual loss in QoL as weight regain occurs. Sustained postoperative benefits depend on maintaining weight. Thus, surgery in itself is an opportunity for lifestyle changes. Without such changes, the benefits accrued during the first years after surgery may be lost, and surgical comorbidities may emerge.

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Original articleComparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls

Abstract

Background

Methods

Results

Conclusion

Section snippets

Patients and procedures

Results

Discussion

Conclusion

Disclosures

J Am Coll Surg

Surg Obes Relat Dis

Prevalence and trends in obesity among US adults, 1999–2000

JAMA

Increases in clinically severe obesity in the United States, 1986–2000

Arch Intern Med

Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old

N Engl J Med

National Institutes of Health Consensus Development Conference Statement: gastrointestinal surgery for obesityNational Institutes of Health, Bethesda, MD, March 25–27, 1991

Am J Clin Nutr

Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report

Obes Res

Bariatric surgery: a systematic review and meta-analysis

JAMA

Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery

N Engl J Med

Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients

Ann Surg

Outcome predictors in morbidly obese recipients of an adjustable gastric band

Obes Surg

Laparoscopic adjustable silicone gastric banding (LAP-BAND): how to avoid complications

Obes Surg

Original article
Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls