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Flum DR, Salem L, Broeckel Elrod JA, Dellinger EP, Cheadle A, Chan L. Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical
Procedures. JAMA. 2005;294(15):1903–1908. doi:10.1001/jama.294.15.1903
Author Affiliations: Departments of Surgery
(Drs Flum, Salem, Broeckel Elrod, and Dellinger), Health Services (Drs Flum
and Cheadle), and Rehabilitation Medicine (Dr Chan), University of Washington,
and the Division of Clinical Standards and Quality, Centers for Medicare and
Medicaid Services, Region 10 (Dr Chan), Seattle, Wash.
Context Case series demonstrate that bariatric surgery can be performed with
a low rate of perioperative mortality (0.5%), but the rate among high-risk
patients and the community at large is unknown.
Objectives To evaluate the risk of early mortality among Medicare beneficiaries
and to determine the relative risk of death among older patients.
Design Retrospective cohort study.
Setting and Patients All fee-for-service Medicare beneficiaries, 1997-2002.
Main Outcome Measures Thirty-day, 90-day, and 1-year postsurgical all-cause mortality among
patients undergoing bariatric procedures.
Results A total of 16 155 patients underwent bariatric procedures (mean
age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day,
and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher
rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7%
at 30 days, 90 days, and 1 year, respectively; P<.001).
Mortality rates were greater for those aged 65 years or older compared with
younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1%
vs 3.9% at 1 year; P<.001). After adjustment for
sex and comorbidity index, the odds of death within 90 days were 5-fold greater
for older Medicare beneficiaries (aged ≥75 years; n = 136) than
for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence
interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95%
confidence interval, 1.3-2.0) for patients of surgeons with less than the
median surgical volume of bariatric procedures (among Medicare beneficiaries
during the study period) after adjusting for age, sex, and comorbidity index.
Conclusions Among Medicare beneficiaries, the risk of early death after bariatric
surgery is considerably higher than previously suggested and associated with
advancing age, male sex, and lower surgeon volume of bariatric procedures.
Patients aged 65 years or older had a substantially higher risk of death within
the early postoperative period than younger patients.
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