Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures | Bariatric Surgery | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002.  JAMA. 2004;291:2847-285015199035Google ScholarCrossref
McTigue KM, Harris R, Hemphill B.  et al.  Screening and interventions for obesity in adults.  Ann Intern Med. 2003;139:933-94914644897Google ScholarCrossref
Sjostrom L, Lindroos AK, Peltonen M.  et al.  Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.  N Engl J Med. 2004;351:2683-269315616203Google ScholarCrossref
Buchwald H, Avidor Y, Braunwald E.  et al.  Bariatric surgery: a systematic review and meta-analysis.  JAMA. 2004;292:1724-173715479938Google ScholarCrossref
Pories WJ, MacDonald KG Jr, Morgan EJ.  et al.  Surgical treatment of obesity and its effect on diabetes: 10-y follow-up.  Am J Clin Nutr. 1992;55:582S-585S1733132Google Scholar
Arterburn DE, Crane PK, Sullivan SD. The coming epidemic of obesity in elderly Americans.  J Am Geriatr Soc. 2004;52:1907-191215507070Google ScholarCrossref
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis.  J Am Coll Surg. 2004;199:543-55115454136Google ScholarCrossref
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.  J Clin Epidemiol. 1992;45:613-6191607900Google ScholarCrossref
Evans S, Li L. A comparison of goodness of fit tests for the logistic GEE model.  Stat Med. 2005;24:1245-126115580592Google ScholarCrossref
Sugerman HJ, DeMaria EJ, Kellum JM, Sugerman EL, Meador JG, Wolfe LG. Effects of bariatric surgery in older patients.  Ann Surg. 2004;240:243-24715273547Google ScholarCrossref
Gonzalez R, Lin E, Mattar SG, Venkatesh KR, Smith CD. Gastric bypass for morbid obesity in patients 50 years or older.  Am Surg. 2003;69:547-55312889614Google Scholar
Livingston EH, Huerta S, Arthur D, Lee S, De Shields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery.  Ann Surg. 2002;236:576-58212409663Google ScholarCrossref
Printen KJ, Mason EE. Gastric bypass for morbid obesity in patients more than fifty years of age.  Surg Gynecol Obstet. 1977;144:192-194835056Google Scholar
Sosa JL, Pombo H, Pallavicini H, Ruiz-Rodriguez M. Laparoscopic gastric bypass beyond age 60.  Obes Surg. 2004;14:1398-140115603658Google ScholarCrossref
Hannan EL, Kilburn H Jr, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State.  JAMA. 1994;271:761-7668114213Google ScholarCrossref
Frostick SP. Death after joint replacement.  Haemostasis. 2000;30:(suppl 2)  84-8711251348Google Scholar
Zenilman ME. Surgery in the elderly.  Curr Probl Surg. 1998;35:99-1799501842Google ScholarCrossref
Harris TB, Savage PJ, Tell GS, Haan M, Kumanyika S, Lynch JC. Carrying the burden of cardiovascular risk in old age: associations of weight and weight change with prevalent cardiovascular disease, risk factors, and health status in the Cardiovascular Health Study.  Am J Clin Nutr. 1997;66:837-8449322558Google Scholar
Clegg A, Colquitt J, Sidhu M.  et al.  Clinical and cost effectiveness of surgery for morbid obesity.  Int J Obes Relat Metab Disord. 2003;27:1167-117714513064Google ScholarCrossref
Kral JG, Sjostrom LV, Sullivan MB. Assessment of quality of life before and after surgery for severe obesity.  Am J Clin Nutr. 1992;55:611S-614S1733139Google Scholar
Christou NV, Sampalis JS, Liberman M.  et al.  Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients.  Ann Surg. 2004;240:416-42315319713Google ScholarCrossref
MacDonald KG Jr, Long SD, Swanson MS.  et al.  The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus.  J Gastrointest Surg. 1997;1:213-2209834350Google ScholarCrossref
Zizza CA, Herring AH, Stevens J, Carey TS. Bariatric surgeries in North Carolina, 1990 to 2001: a gender comparison.  Obes Res. 2003;11:1519-152514694217Google ScholarCrossref
Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary.  Surgery. 2003;134:613-62114605622Google ScholarCrossref
Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The relationship between hospital volume and outcome in bariatric surgery at academic medical centers.  Ann Surg. 2004;240:586-59315383786Google Scholar
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States.  N Engl J Med. 2003;349:2117-212714645640Google ScholarCrossref
Original Contribution
October 19, 2005

Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures

Author Affiliations

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.

JAMA. 2005;294(15):1903-1908. doi:10.1001/jama.294.15.1903

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.