Surgery News - October 2007 - (Page 14)

14 GENERAL SURGERY SURGERY NEWS • O C T O B E R 2 0 0 7 New Data Show Mortality Drop After Bariatric Surgery B Y M A RY A N N M O O N Else vier Global Medical Ne ws wo research groups have found the long-sought evidence that the benefits of bariatric surgery translate into decreased mortality for obese patients. Investigators believe they now have that evidence. Dr. Lars Sjöström and his associates in the Swedish Obese Subjects (SOS) Study found a significant 29% reduction in the adjusted hazard ratio for death in the 11 years following bariatric surgery. And T Dr. Ted D. Adams, University of Utah, Salt Lake City, and his associates found that the procedures reduced the rates of death from all causes by 40%, from diabetes by 92%, from coronary artery disease (CAD) by 56%, and from cancer by 60%. The prospective SOS studied 2,010 obese patients who underwent adjustable or nonadjustable banding (19%), vertical banded gastroplasty (68%), or gastric bypass (13%) in Sweden from 1987 to 2001 and were followed for a mean of 11 years. These surgical subjects were matched on 18 factors to 2,037 control subjects who received conventional treatment for obesity, “which ranged from sophisticated lifestyle intervention and behavior modification to no treatment whatsoever,” said Dr. Sjöström of Gothenburg University, Sweden, and his associates. For up to 15 years during which weights were recorded, the average weight change in controls varied less than 2 pounds. Maximum losses in the surgical groups were seen after 1 to 2 years, but weight losses from baseline stabilized at 10 years—at NOW AVAILABLE : ATLS FOR DOCTORS STUDENT MANUAL, 7TH EDITION 14% for banding, 16% for vertical banded gastroplasty, and 25% for gastric bypass. Cumulative overall mortality was 5% in the surgery patients, compared with 6.3% in the control group. The surgery patients’ adjusted hazard ratio for death was 0.71 (N. Engl. J. Med. 2007;357:741-52). “We cannot evaluate the effects of weight loss on death rate separately within the two study groups, given the limits of our study’s statistical power. we cannot determine whether the favorable survival effect of bariatric surgery is explained by weight loss or by other beneficial effects of the surgical procedures,” they noted. Dr. Adams and his associates conducted a retrospective cohort study to compare death rates between 7,925 markedly obese adults with Roux-en-Y gastric bypass surgery from 1984 to 2002 and an equal number of obese people randomly selected from the general population. Mean follow-up was 7 years, but some patients were followed for as long as 18 years. Mortality from any cause was 40% lower in the surgery group than the control, after adjustment for sex, age, and body THE CRITERIA FOR SELECTING PATIENTS FOR BARIATRIC SURGERY MAY NEED TO BE REEXAMINED IN LIGHT OF THESE FINDINGS. mass index. Rates of death from diabetes, CAD, and cancer were markedly lower in surgery patients, but this was partially offset by higher rates of death due to nondisease causes such as trauma and suicide. An estimated 171 deaths from disease were prevented per 10,000 gastric bypass procedures, but there was an increase of 35 nondisease deaths, for a net prevention of 136 deaths per 10,000 surgeries, Dr. Adams and his associates said (N. Engl. J. Med. 2007;357:753-61). This study also could not establish whether mortality benefits were due directly to weight loss or from other factors. Bariatric surgery, particularly gastric bypass, has been shown to induce substantial and sustained weight loss and to improve diabetes, sleep apnea, joint pain, and cardiovascular risk factors. “What has been missing from the equation is a demonstration that improvement in these risk factors translates into a longer life,” Dr. George A. Bray said in an accompanying editorial (N. Engl. J. Med. 2007;357:818-9). Dr. Bray, of Louisiana State University, Baton Rouge, said that the criteria for selecting patients for bariatric surgery may need to be reexamined in light of these findings. Current criteria, published in 1991, call for surgery only if other forms of treatment have failed and only in patients with a body mass index (BMI) of 40 or more (or a BMI of 35 or more in the presence of coexisting illness). If the surgery reduces overall diabetes, cancer, and cardiovascular mortality, it may well be time to reconsider those guidelines, he said. ■ The ATLS® Program was developed to teach doctors one safe, reliable method for assessing and initially managing the trauma patient. The course teaches an organized approach for evaluation and management of seriously injured patients and offers a foundation of common knowledge for all members of the trauma team. The emphasis is on the critical “ﬁrst hour” of care, focusing on initial assessment, lifesaving intervention, reevaluation, stabilization, and, when needed, transfer to a trauma center. This publication, in its 7th edition, was written for use in ATLS Student Courses and is updated approximately every four years. Price: $80 each To obtain an ATLS for Doctors Student Manual, visit the American College of Surgeons online publication catalog at: https://web2.facs.org/timssnet464/acspub/frontpage. cfm?product_class=trauma https://web2.facs.org/timssnet464/acspub/frontpage.cfm?product_class=trauma

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