Background
This is the first systematic review and meta-analysis of published mortality data
after bariatric surgery.
Methods
The review includes all papers published in English from January 1, 1990 to April
30, 2006, identified through electronic searches in MEDLINE, Current Contents, and
the Cochrane Library, supplemented by manual reference checks. All accepted studies
were assigned a level of evidence (Centre for Evidence-Based Medicine, Oxford, UK),
and randomized controlled trials were rated for quality using the Jadad scoring method.
Random effects meta-analyses were performed. Mortality was analyzed at either ≤30
days or 30 days to 2 years.
Results
The data set includes 361 studies with 478 treatment arms and 85,048 patients. At
baseline, the mean age was 40.0 years, body mass index was 47.4 kg/m2, 85% were female, and 11.5% had previous bariatric procedures. Meta-analysis of total
mortality at ≤30 days was 0.28% (95% confidence interval [CI], 0.22-0.34) in 475 treatment
arms (n = 84,931); total mortality at >30 days to 2 years was 0.35% (95% CI, 0.12-0.58) in
140 treatment arms (n = 19,928). Mortality at ≤30 day for all restrictive procedures was 0.30% (95% CI,
0.15-0.46) for open and 0.07% (95% CI, 0.02-0.12) for laparoscopic procedures; restrictive/malabsorptive
(gastric bypass) was 0.41% (95% CI, 0.24-0.58] for open and 0.16% (95% CI, 0.09-0.23)
for laparoscopic; and malabsorptive was 0.76% (95% CI, 0.29-1.23) for open and 1.11%
(95% CI, 0.00-2.70) for laparoscopic. Subgroup analyses of ≤30-day mortality show
a male:female ratio of 4.74:0.13, with 1.25% (95% CI, 0.56-1.94) incidence in the
superobese and 0.34% (95% CI, 0.00-1.29) in the elderly (≥65 years).
Conclusion
The early and late mortality rates after bariatric surgery are low and can be subjected
to risk stratification for comparative analyses and prospective risk assessments.
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Article info
Publication history
Accepted:
July 26,
2007
Footnotes
Supported by Ethicon Endo-Surgery, a Johnson & Johnson Company, 4370 Creek Road, Cincinnati, OH 45242.
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
