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All-Cause Mortality of Patients With and Without Diabetes Following Bariatric Surgery: Comparison to Non-surgical Matched Patients

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Abstract

Objective

Data are sparse regarding the survival benefit of bariatric surgery on mortality among persons with diabetes. We aimed to investigate the association of bariatric surgery, compared with usual care, on all-cause mortality in individuals who underwent surgery and matched controls, stratified by the presence of diabetes.

Research Design and Methods

This retrospective cohort study utilized population-based electronic medical record data. Individuals who underwent one of three types of bariatric surgery during 2005–2014 were included. For each surgical patient, three non-surgical individuals were matched according to age, sex, body mass index, and diabetes status. The cohort comprised 9564 individuals with diabetes and 23,976 individuals without diabetes.

Results

During a median follow-up of 4.2 years, adjusted hazard ratios (HRs) for mortality for non-surgery vs. surgery were 2.38 (95%CI: 1.75, 3.26) and 1.73 (95%CI: 1.26, 2.36) among individuals with diabetes and individuals without diabetes, respectively. Considered separately, HRs for mortality for laparoscopic banding, gastric bypass, and laparoscopic sleeve gastrectomy were 2.83 (95%CI: 1.73, 4.63), 2.30 (95%CI: 1.25, 4.25), and 1.89 (95%CI: 1.1, 3.32) among patients with diabetes; and 1.74 (95%CI: 1.20, 2.52), 2.66 (0.81, 8.76), and 1.16 (0.51, 2.65) among patients without diabetes.

Conclusion

The survival advantage of bariatric surgery after a median follow-up of 4.2 years was greater among individuals with than without diabetes for the three types of surgery performed. Longer follow-up is needed to examine the effect on survival in individuals without diabetes who undergo bariatric surgery. These results suggest priority considerations for bariatric surgery candidates.

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Acknowledgments

We thank Ilan Gofer, of the Clalit Research Institute (CRI), for data extraction.

Funding

This project was undertaken by the Clalit Research Institute as part of its role in providing policy decision-making support as an internal branch of the Clalit Health Services healthcare organization.

Author information

Authors and Affiliations

  1. Internal Medicine Department, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel

    Dror Dicker

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Dror Dicker

  3. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Philip Greenland, Laura J. Rasmussen-Torvik & Orna Reges

  4. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Philip Greenland

  5. Clalit Research Institute, Clalit Health Services, Ramat-Gan, Israel

    Morton Leibowitz, Moshe Hoshen, Adi Berliner Senderey, Ran D. Balicer & Orna Reges

  6. Department of Medicine, School of Medicine, New York University, New York, NY, USA

    Morton Leibowitz

  7. National Information Systems, Computational Authority, Ministry of Health, Jerusalem, Israel

    Moshe Hoshen

  8. Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Laura J. Rasmussen-Torvik

  9. Department of Epidemiology, Ben Gurion University of the Negev, Beer Sheva, Israel

    Ran D. Balicer

Authors
  1. Dror Dicker
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  2. Philip Greenland
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  3. Morton Leibowitz
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  4. Moshe Hoshen
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  5. Adi Berliner Senderey
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  6. Laura J. Rasmussen-Torvik
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  7. Ran D. Balicer
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  8. Orna Reges
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Correspondence to Dror Dicker.

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For this type of study (retrospective), formal consent is not required. Informed consent does not apply.

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The authors declare that they have no conflict of interest.

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Dicker, D., Greenland, P., Leibowitz, M. et al. All-Cause Mortality of Patients With and Without Diabetes Following Bariatric Surgery: Comparison to Non-surgical Matched Patients. OBES SURG 31, 755–762 (2021). https://doi.org/10.1007/s11695-020-05068-0

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  • DOI: https://doi.org/10.1007/s11695-020-05068-0

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