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Survival and Changes in Comorbidities After Bariatric Surgery

Perry, Cynthia D. PhD*; Hutter, Matthew M. MD, MPH; Smith, Daniel B. MA; Newhouse, Joseph P. PhD‡§¶; McNeil, Barbara J. MD, PhD‡∥

doi: 10.1097/SLA.0b013e318142cb4b
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Objective: To evaluate survival rates and changes in weight-related comorbid conditions after bariatric surgery in a high-risk patient population as compared with a similar cohort of morbidly obese patients who did not undergo surgery.

Summary Background Data: Morbid obesity is increasingly becoming a major public health issue. Existing studies are limited in their ability to assess the risks and benefits of bariatric surgery because few studies compare surgical patients to a similar, morbidly obese, nonsurgical cohort, especially in high-risk populations like the elderly and disabled.

Methods: A retrospective cohort analysis using Medicare fee-for-service patients from 2001 to 2004. Survival rates and diagnosed presence of 5 conditions commonly comorbid with morbid obesity were examined for morbidly obese patients who did and did not undergo bariatric surgery, with up to 2 years follow-up.

Results: Morbidly obese Medicare patients who underwent bariatric surgery had increased survival rates over the 2 years of this study when compared with a similar morbidly obese nonsurgical group (P < 0.001). For patients under the age of 65, this survival advantage started at 6 months postoperatively and for patients over age 65, at 11 months. The surgical group also experienced significant improvements in the diagnosed prevalence of 5 weight-related comorbid conditions (diabetes, sleep apnea, hypertension, hyperlipidemia, and coronary artery disease) relative to the nonsurgical cohort after 1 year postsurgery (P < 0.001).

Conclusions: Bariatric surgery appears to increase survival even in the high-risk, Medicare population, both for individuals aged 65 and older and those disabled and under 65. In addition, the diagnosed prevalence of weight-related comorbid conditions declined after bariatric surgery relative to a control cohort of morbidly obese patients who did not undergo surgery.

We evaluated survival rates and presence of comorbidities for morbidly obese patients who underwent bariatric surgery as compared with similar morbidly obese patients who did not. We found higher survival rates and lower presence of comorbid conditions at up to 2 years for surgical patients compared with those without surgery.

From the *Urban Institute, Washington, DC; †Department of Surgery at the Massachusetts General Hospital; ‡Department of Health Care Policy at Harvard Medical School, Boston, MA; §Kennedy School of Government, Cambridge, MA; ¶Department of Health Policy and Management at the Harvard School of Public Health; and ∥Department of Radiology at the Brigham and Women’s Hospital, Boston, MA.

During the time of this study, Cynthia Perry was supported through the Robert Wood Johnson Foundation’s Scholars in Health Policy Fellowship Program.

Reprints: Cynthia D. Perry, PhD, The Urban Institute, 2100 M Str., N.W., Washington, DC 20037. E-mail: cperry@ui.urban.org.

© 2008 Lippincott Williams & Wilkins, Inc.