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Bariatric Surgery for Diabetics May Not Be Worth The Risk

Life expectancy may be reduced after bariatric surgery for patients with a BMI more than 62 kg/m2 …

Super obese patients with diabetes may not get the same benefits from bariatric surgery as those who with BMIs less than 62, according to published research.

“For most patients with diabetes and a BMI greater than 35, bariatric surgery increases life expectancy,” Daniel Schauer, MD, assistant professor in the Division of General Internal Medicine at the University of Cincinnati, said in a press release. “However, the benefit of surgery decreases as BMI increases. The patients with a BMI over 62 likely don’t gain any life expectancy with surgery.”

For the study, Dr. Schauer and colleagues compared life expectancy in severely obese patients with diabetes who underwent bariatric surgery with those who did not. They included data from about 200,000 patients from the HMO Research Network sites, the Nationwide Inpatient Sample and the National Health Interview Survey linked to the National Death Index.

Data showed that a 45-year-old woman with diabetes and a BMI of 45 gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs. 31.7 years without surgery), but this gain declined once BMI reached 62. At this point, nonsurgical treatment was linked to greater life expectancy.

Results were similar for men and women, but the researchers did not examine differences according to race.

“This was surprising. We expected those with higher BMIs to benefit more from bariatric surgery,” said Dr. Schauer, also a University of Cincinnati Health physician and member of both the University of Cincinnati Cancer Institute and the Center for Clinical Effectiveness.

The objective was to create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes.

Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified.
They developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients.

Results offer insight into the benefits of bariatric surgery in a patient population with both diabetes and severe obesity. The data were somewhat unexpected, according to one study researcher.

Practice Pearls:

  • Life expectancy may be reduced after bariatric surgery for patients with a BMI more than 62 kg/m2.
  • The researchers noted that the declining benefit of bariatric surgery with increasing BMI may have several causes.
  • Long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified.

Daniel P. Schauer. Impact of Bariatric Surgery on Life Expectancy in Severely Obese Patients With Diabetes: A Decision Analysis, Annals of Surgery, Jan 23, 2015, doi: 10.1097/SLA.0000000000000907