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Antiobesity Surgery in Sweden From 1980 to 2005: A Population-Based Study With A Focus on Mortality

Marsk, Richard MD*; Freedman, Jacob MD, PhD*; Tynelius, Per MSc; Rasmussen, Finn MD, PhD; Näslund, Erik MD, PhD*

doi: 10.1097/SLA.0b013e318189b0cf
Original Articles

Background: Antiobesity surgery reduces mortality, but this reduction is dependent to a great extent on surgical perioperative mortality. Population-based perioperative mortality after antiobesity surgery is not well known.

Objective: To evaluate mortality after antiobesity surgery in Sweden.

Design: Retrospective cohort study.

Setting: All patients who underwent antiobesity surgery in Sweden between 1980 and 2005.

Main Outcome Measures: All-cause mortality after antiobesity surgery.

Results: A total of 12,379 patients (9,614 women) with mean age (±SD) of 39.5 ± 10.4 years underwent 14,768 antiobesity procedures. Mean follow-up time was 10.9 ± 6.3 years. A total of 751 (6.1%) patients died during the follow-up period and the cumulative 30-day, 90-day, and 1-year mortality was 0.2, 0.3, and 0.5%, respectively. Early cumulative mortality was higher for men and patients older than 50 years of age. Long-term mortality was higher in men than in women (90 vs. 50 per 10,000 person years when excluding early deaths, mortality rate ratio 1.8 (95% CI, 1.5–2.1)). There was no difference in the rates of early mortality when primary procedures were compared with reoperations. Myocardial infarction and malignancy were the most common late causes of death after surgery.

Conclusions: Antiobesity surgery can be performed safely in unselected populations of obese patients with low rates of early mortality. Men are at a higher risk of early death, which is carried through over long-term follow-up, and that is why a future specific study of the effect of antiobesity surgery on mortality in men is warranted.

Between 1980 and 2005, 12,379 patients underwent antiobesity surgery in Sweden. Cumulative 30-day mortality was 0.2%, and early (≤1 year) cumulative mortality was higher for men and patients older than 50 years of age. Long-term mortality was also higher in men than in women.

From the *Division of Surgery, Department of Clinical Sciences, Danderyd Hospital; and the †Department of Public Health Sciences; Karolinska Institutet, Stockholm, Sweden.

This study was supported by the Swedish Research Council, Stockholm Council, and Funds of the Karolinska Institutet.

Reprints: Richard Marsk, MD, Department of Surgery, Danderyd Hospital, SE-182 88 Stockholm, Sweden. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.