Super-Obesity Ups Risk of Bariatric Surgery Death

Veterans classified as super-obese and those with a higher chronic disease burden appeared more likely to die within a year of having bariatric surgery, according to a new study.

Evidence suggests bariatric surgery is one of the few interventions that can help morbidly obese individuals lose enough weight to significantly improve their health and quality of life. The risk of death associated with bariatric surgery is thought to be low, but most previous studies involved younger women rather than the older male population that typically uses VA facilities.

Currently, 165,000 veterans who use Veterans Affairs (VA) medical facilities have class III obesity, defined as a body mass index (BMI) of 40 or greater.

The number of bariatric procedures performed in VA medical facilities more than tripled between 2000 and 2006. “Whether the volume of the VA bariatric surgery program should be expanded in the coming years largely depends on the impact such operations have on long-term health outcomes,” the authors wrote.

David Arterburn, M.D., M.P.H., of Group Health Research Institute, Seattle, and colleagues examined factors associated with the risk of death among 856 veterans who underwent bariatric surgery in twelve VA bariatric centers from 2000 to 2006. The patients had an average BMI of 48.7 and an average age of 54 years. Seventy-three percent were men.

Overall, a total of 54 patients died during the one-year follow-up period. In statistical models performed by the researchers, the patients who were classified as super-obese — having a BMI of 50 or higher, which accounted for 36 percent of the sample — had an increased risk of death. Super-obese patients had one-year death rates of 5.2 percent, whereas those with a higher co-morbidity cost score had rates that were nearly double, at 10.1 percent.

The authors noted several possible explanations. Bariatric procedures are technically more difficult in these patients because of their abdominal fat. These patients may be at greater risk for wound complications and blood clotting, and they are likely to have more obesity-related illnesses.

“The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery,” the authors were quoted as saying. “These findings also suggest that the risks of bariatric surgery in patients with significant co-morbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with super-obesity.” – Archives of Surgery