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01.12.2014 | Original Article | Ausgabe 12/2014

Journal of Gastrointestinal Surgery 12/2014

Re-examining the BMI Threshold for Bariatric Surgery in the USA

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 12/2014
Autoren:
Rashikh A. Choudhury, K. M. Murayama, C. J. Neylan, G. Savulionyte, H. A. Glick, N. N. Williams, D. T. Dempsey, K. R. Dumon
Wichtige Hinweise
Material for this manuscript submission was presented at the Southwestern Surgical Congress Annual Meeting (April 13–16th, 2014, Scottsdale AZ).

Abstract

Background

The optimal BMI threshold above which gastric bypass surgery should be offered to obese patients is controversial. The objective of this study was to compare the impact of Roux-en-Y gastric bypass (RYGB) vs. diet and exercise (D&E) on life expectancy to find the BMI at which patients experience an improvement in their life expectancy by undergoing surgery.

Methods

A Markov state transition model was designed to implement a decision tree that simulated the lives of obese patients. Life expectancies following RYGB and 2 years of D&E were estimated and compared. Ten thousand patients’ lives were simulated in each weight-loss intervention group in the model. In addition to base case analysis (45 kg/m2 BMI pre-intervention), sensitivity analysis of initial BMI at the start of the study was completed. Markov model parameters were extracted from the literature.

Results

The impact of RYGB on survival relative to D&E depended on the patient’s initial BMI. Compared to patients who underwent 2 years of “optimal” diet and exercise (7 % total body weight loss/year), RYGB improved long-term survival for patients above a BMI of 31.3 kg/m2.

Conclusions

Roux-en-Y gastric bypass can improve long-term survival for patients with class I obesity. This study suggests that RYGB should not be reserved solely for patients with class II or III obesity.

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