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Incidence and Risk Factors for Mortality Following Bariatric Surgery: a Nationwide Registry Study

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Abstract

Background

Although bariatric surgery (BS) is considered safe, concern remains regarding severe post-operative adverse events and mortality. Using a national BS registry, the aim of this study was to assess the incidence, etiologies, and risk factors for mortality following BS.

Methods

Prospective data from the National Registry of Bariatric Surgery in Israel (NRBS) including age, gender, BMI, comorbidities, and surgical procedure information were collected for all patients who underwent BS in Israel between June 2013 and June 2016. The primary study outcome was the 3.5-year post-BS mortality rate, obtained by cross-referencing with the Israel population registry.

Results

Of the 28,755 patients analyzed (67.3% females, mean age 42.0 ± 12.5 years, and preoperative BMI 42.14 ± 5.21 kg/m2), 76% underwent sleeve gastrectomy (SG), 99.1% of the surgeries were performed laparoscopically, and 50.8% of the surgeries were performed in private medical centers. Overall, 95 deaths occurred during the study period (146.9/100,000 person years). The 30-day rate of post-operative mortality was 0.04% (n = 12). Male gender (HR = 1.94, 95%CI 1.16–3.25), age (HR = 1.06, 95%CI 1.04–1.09), BMI (HR = 1.08, 95%CI 1.05–1.11), and depression (HR = 2.38, 95%CI 1.25–4.52) were independently associated with an increased risk of all-cause 3.5-year mortality, while married status (HR = 0.43, 95%CI 0.26–0.71) was associated with a decreased risk.

Conclusion

Mortality after BS is low. Nevertheless, a variety of risk factors including male gender, advanced age, unmarried status, higher BMI, and preoperative depressive disorder were associated with higher mortality rates. Special attention should be given to these “at-risk” BS patients.

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Author notes

  1. Nasser Sakran and Shiri Sherf-Dagan contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery A, Emek Medical Center, 21 IZHAK Rabin Blvd, 1834111, Afula, Israel

    Nasser Sakran & Dan Hershko

  2. Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel

    Nasser Sakran, Dean Keren, Dan Hershko & Ian M. Gralnek

  3. Department of Nutrition, Assuta Medical Center, Tel-Aviv, Israel

    Shiri Sherf-Dagan

  4. Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel

    Orit Blumenfeld, Orly Romano-Zelekha & Tamy Shohat

  5. Assia Medical Group, Assuta Medical Center, Tel-Aviv, Israel

    Asnat Raziel & David Goitein

  6. Department of Gastroenterology, Bnai-Zion Medical Center, Haifa, Israel

    Dean Keren

  7. Diabetes Unit, Hadassah University Hospital, Jerusalem, Israel

    Itamar Raz

  8. Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel

    Ian M. Gralnek

  9. Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel

    Tamy Shohat & David Goitein

  10. Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel

    David Goitein

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  1. Nasser Sakran
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Correspondence to Nasser Sakran.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study were approved by the institutional research committee and in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Sakran, N., Sherf-Dagan, S., Blumenfeld, O. et al. Incidence and Risk Factors for Mortality Following Bariatric Surgery: a Nationwide Registry Study. OBES SURG 28, 2661–2669 (2018). https://doi.org/10.1007/s11695-018-3212-1

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