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ACS: Gastric Bypass Surgery Has High Short-term Mortality But Improves Long-Term Survival By W. A. Thomasson, PhD CHICAGO, IL -- November 7, 2003 -- Almost 2% of the patients undergoing gastric bypass surgery for morbid obesity will die within the first 30 days, according to a report presented October 21st at the American College of Surgeons 2003 Clinical Congress. David R. Flum, MD, MPH, and E. Patchen Dellinger, MD, University of Washington, Seattle, Washington, United States, said this mortality rate is four times that extrapolated from reported case series of experienced surgeons. The good news, however, is that gastric bypass patients reduced by 4.5% their chance of dying over the next 15 years, they said. The study used data from an administrative database that reflected hospital admissions in the state of Washington for 1987 through 2001. Patients who were admitted to a hospital with a diagnosis of obesity or morbid obesity and underwent gastric bypass surgery were compared with patients who did not undergo such surgery (excluding those who died during that hospital admission). Patients with co-morbidities such as HIV infection or cancer that might have confounded the results were excluded in both groups. There were 62,781 patients in the surgery group and 3,328 in the control group. The two groups had identical Charlson score, an index of co-morbidity. However, patients undergoing surgery were a few years younger, more likely to be female, and more likely to have diabetes or renal disease, but were less likely to have liver disease. The researchers found that 1.02% of surgical patients died in the hospital but when they added those patients who died shortly after hospital discharge, the total 30-day mortality was 1.9%. There was a non-significant decrease in 30-day mortality after the introduction of laparoscopic surgery in 1997. There was, however, a strong correlation with surgeon experience. Surgeons who had done fewer than 20 such procedures had almost a 5% rate of 30-day mortality while for those who had done 250 or more procedures had a rate that was nearly zero. Follow-up ranged as high as 15.5 years, with a median of 4.4 years and 25% of the patients having been followed for at least 8.1 years. Cox regression analysis indicated an expected 15-year survival of 11.8% for operated patients and 16.3% for control patients. The difference was even greater for patients under age 40 years -- 13.8% versus 3% -- although this calculation is based on a relatively small number of events. For all patients who survived for 1 year, the chance of death thereafter was one-third lower if they had had the operation. These data thus support the benefits of gastric bypass surgery and informs the cost-benefit analysis that insurers and others are now carrying out. They also, however, indicate that institutions need to take steps to minimise the effects of surgeon inexperience. [Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study] E-mail this page to a friend or colleague! To print, use this version