Obesity Surgery

, Volume 28, Issue 9, pp 2661–2669 | Cite as

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

  • Nasser SakranEmail author
  • Shiri Sherf-Dagan
  • Orit Blumenfeld
  • Orly Romano-Zelekha
  • Asnat Raziel
  • Dean Keren
  • Itamar Raz
  • Dan Hershko
  • Ian M. Gralnek
  • Tamy Shohat
  • David Goitein
Original Contributions



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.


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.


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.


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.


Bariatric surgery Registry Mortality 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Statement of Informed Consent

For this type of study, formal consent is not required.

Supplementary material

11695_2018_3212_MOESM1_ESM.docx (16 kb)
Supplementary Table 1 (DOCX 15 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Nasser Sakran
    • 1
    • 2
    Email author
  • Shiri Sherf-Dagan
    • 3
  • Orit Blumenfeld
    • 4
  • Orly Romano-Zelekha
    • 4
  • Asnat Raziel
    • 5
  • Dean Keren
    • 2
    • 6
  • Itamar Raz
    • 7
  • Dan Hershko
    • 1
    • 2
  • Ian M. Gralnek
    • 2
    • 8
  • Tamy Shohat
    • 4
    • 9
  • David Goitein
    • 5
    • 9
    • 10
  1. 1.Department of Surgery AEmek Medical CenterAfulaIsrael
  2. 2.Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
  3. 3.Department of NutritionAssuta Medical CenterTel-AvivIsrael
  4. 4.Israel Center for Disease ControlMinistry of HealthTel HashomerIsrael
  5. 5.Assia Medical GroupAssuta Medical CenterTel-AvivIsrael
  6. 6.Department of GastroenterologyBnai-Zion Medical CenterHaifaIsrael
  7. 7.Diabetes UnitHadassah University HospitalJerusalemIsrael
  8. 8.Ellen and Pinchas Mamber Institute of Gastroenterology and HepatologyEmek Medical CenterAfulaIsrael
  9. 9.Sackler School of MedicineTel Aviv UniversityTel-AvivIsrael
  10. 10.Department of Surgery CSheba Medical CenterTel HashomerIsrael

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