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 19 February 2018

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News

Mortality high in medicare patients after bariatric surgery

Among Medicare beneficiaries, the risk of early death after bariatric surgery is higher than previously suggested, and is associated with advancing age, male sex, and lower surgeon volume of bariatric procedures, finds the latest JAMA.

News image

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Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality.

However, the rate among high-risk patients and the community at large is unknown.

Dr David Flum and colleagues evaluated the risk of early mortality among Medicare beneficiaries.

The researchers determined the relative risk of death among older patients by conducting a retrospective cohort stud.

The research team included all fee-for-service Medicare beneficiaries between 1997 and 2002.

The main outcome measures were 30-day, 90-day, and 1-year postsurgical all-cause mortality among patients undergoing bariatric procedures.

Mortality rates for patients older than 65 years was 11% vs 4% for those younger
Journal of the American Medical Association

A total of 16,155 patients underwent bariatric procedures with a mean age of 48 years, of which 76% were women.

The team found that the rates of 30-day, 90-day, and 1-year mortality were 2%, 3%, and 5%, respectively.

The researchers observed that men had higher rates of early death than women.

Mortality rates were greater for those aged 65 years or older compared with younger patients with 5% vs 2% at 30 days.

The team noted that mortality rates for over 65 years at 90 days was 7% vs 2% for younger patients.

At 1 year, the mortality rate for patients older than 65 years was 11% vs 4% for those younger.

After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for those 75 years and older than for those aged 65 to 74 years.

The team found that the odds of death at 90 days were 2 times higher for patients of surgeons with less than the median surgical volume of bariatric procedures.

The researchers had adjusted for age, sex, and comorbidity index.

Dr Flum's team concludes, “Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested.”

“It is associated with advancing age, male sex, and lower surgeon volume of bariatric procedures.”

“Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients.”

JAMA 2005: 294: 1903-8
24 October 2005

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