All-Cause Mortality of Patients With and Without Diabetes Following Bariatric Surgery: Comparison to Non-surgical Matche
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ORIGINAL CONTRIBUTIONS
All-Cause Mortality of Patients With and Without Diabetes Following Bariatric Surgery: Comparison to Non-surgical Matched Patients Dror Dicker 1,2 & Philip Greenland 3,4 & Morton Leibowitz 5,6 & Moshe Hoshen 5,7 & Adi Berliner Senderey 5 & Laura J. Rasmussen-Torvik 3,8 & Ran D. Balicer 5,9 & Orna Reges 3,5 Received: 25 April 2020 / Revised: 20 October 2020 / Accepted: 21 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective Data are sparse regarding the survival benefit of bariatric surgery on mortality among persons with diabetes. We aimed to investigate the association of bariatric surgery, compared with usual care, on all-cause mortality in individuals who underwent surgery and matched controls, stratified by the presence of diabetes. Research Design and Methods This retrospective cohort study utilized population-based electronic medical record data. Individuals who underwent one of three types of bariatric surgery during 2005–2014 were included. For each surgical patient, three non-surgical individuals were matched according to age, sex, body mass index, and diabetes status. The cohort comprised 9564 individuals with diabetes and 23,976 individuals without diabetes. Results During a median follow-up of 4.2 years, adjusted hazard ratios (HRs) for mortality for non-surgery vs. surgery were 2.38 (95%CI: 1.75, 3.26) and 1.73 (95%CI: 1.26, 2.36) among individuals with diabetes and individuals without diabetes, respectively. Considered separately, HRs for mortality for laparoscopic banding, gastric bypass, and laparoscopic sleeve gastrectomy were 2.83 (95%CI: 1.73, 4.63), 2.30 (95%CI: 1.25, 4.25), and 1.89 (95%CI: 1.1, 3.32) among patients with diabetes; and 1.74 (95%CI: 1.20, 2.52), 2.66 (0.81, 8.76), and 1.16 (0.51, 2.65) among patients without diabetes. Conclusion The survival advantage of bariatric surgery after a median follow-up of 4.2 years was greater among individuals with than without diabetes for the three types of surgery performed. Longer follow-up is needed to examine the effect on survival in individuals without diabetes who undergo bariatric surgery. These results suggest priority considerations for bariatric surgery candidates. Keywords Bariatric surgery . Roux-en-Y gastric bypass . Gastric banding . Sleeve gastrectomy . Mortality . Diabetes . Subgroups
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11695-02005068-0. * Dror Dicker [email protected] 1
Internal Medicine Department, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel
2
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
3
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
4
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
5
Clalit Research Institute, Clalit Health Services, Ramat-Gan, Israel
6
Department of Medicine, School of Medicine, New York University, New Yo
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