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Published in: Obesity Surgery 11/2011

01-11-2011 | Clinical Research

Thirty-day Mortality After Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery

Authors: Mark D. Smith, Emma Patterson, Abdus S. Wahed, Steven H. Belle, Paul D. Berk, Anita P. Courcoulas, Gregory F. Dakin, David R. Flum, Laura Machado, James E. Mitchell, John Pender, Alfons Pomp, Walter Pories, Ramesh Ramanathan, Beth Schrope, Myrlene Staten, Akuezunkpa Ude, Bruce M. Wolfe

Published in: Obesity Surgery | Issue 11/2011

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Abstract

Background

Mortality following bariatric surgery is a rare event in contemporary series, making it difficult for any single center to draw meaningful conclusions as to cause of death. Nevertheless, much of the published mortality data come from single-center case series and reviews of administrative databases. These sources tend to produce lower mortality estimates than those obtained from controlled clinical trials. Furthermore, information about the causes of death and how they were determined is not always available. The aim of the present report is to describe in detail all deaths occurring within 30 days of surgery in the Longitudinal Assessment of Bariatric Surgery (LABS).

Methods

LABS is a ten-center observational cohort study of bariatric surgical outcomes. Data were collected prospectively for bariatric surgeries performed between March 2005 and April 2009. All deaths occurring within 30-days of surgery were identified, and cause of death assigned by an independent Adjudication Subcommittee, blinded to operating surgeon and site.

Results

Six thousand one hundred eighteen patients underwent primary bariatric surgery. Eighteen deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%), and pulmonary embolism (17%). For one patient cause of death could not be determined despite examination of all available information.

Conclusions

This study confirms the low 30-day mortality rate following bariatric surgery. The recognized complications of anastomotic leak, cardiac events, and pulmonary emboli accounted for the majority of 30-day deaths.
Literature
1.
go back to reference Flegal KM, Carroll MD, Kuczmarski RJ, et al. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord. 1998;22:39–47.PubMedCrossRef Flegal KM, Carroll MD, Kuczmarski RJ, et al. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord. 1998;22:39–47.PubMedCrossRef
2.
go back to reference Kuczmarski RJ, Flegal KM, Campbell SM, et al. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA. 1994;272:205–11.PubMedCrossRef Kuczmarski RJ, Flegal KM, Campbell SM, et al. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA. 1994;272:205–11.PubMedCrossRef
3.
go back to reference Ford ES, Mokdad AH. Epidemiology of obesity in the Western Hemisphere. J Clin Endocrinol Metab. 2008;93:S1–8.PubMedCrossRef Ford ES, Mokdad AH. Epidemiology of obesity in the Western Hemisphere. J Clin Endocrinol Metab. 2008;93:S1–8.PubMedCrossRef
4.
go back to reference Low S, Chin MC, Deurenberg-Yap M. Review on epidemic of obesity. Ann Acad Med Singapore. 2009;38:57–9.PubMed Low S, Chin MC, Deurenberg-Yap M. Review on epidemic of obesity. Ann Acad Med Singapore. 2009;38:57–9.PubMed
5.
go back to reference Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93:S9–30.PubMedCrossRef Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93:S9–30.PubMedCrossRef
6.
go back to reference Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.PubMedCrossRef Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.PubMedCrossRef
7.
go back to reference Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–9.PubMedCrossRef Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363:2211–9.PubMedCrossRef
8.
go back to reference Jacobs EJ, Newton CC, Wang Y, et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med. 2010;170:1293–301.PubMedCrossRef Jacobs EJ, Newton CC, Wang Y, et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med. 2010;170:1293–301.PubMedCrossRef
11.
go back to reference Pories WJ, Swanson MS, MacDonald KG et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50; discussion 350–2. Pories WJ, Swanson MS, MacDonald KG et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50; discussion 350–2.
12.
go back to reference Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.PubMedCrossRef Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236:554–9.PubMedCrossRef
13.
go back to reference Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRef Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRef
14.
go back to reference Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRef Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRef
15.
go back to reference Livingston EH. Procedure incidence and in-hospital complication rates of bariatric surgery in the United States. Am J Surg. 2004;188:105–10.PubMedCrossRef Livingston EH. Procedure incidence and in-hospital complication rates of bariatric surgery in the United States. Am J Surg. 2004;188:105–10.PubMedCrossRef
16.
18.
go back to reference Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMed Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMed
19.
go back to reference Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54.PubMedCrossRef Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54.PubMedCrossRef
20.
go back to reference DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6:347–55.PubMedCrossRef DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6:347–55.PubMedCrossRef
21.
go back to reference Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.PubMedCrossRef Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.PubMedCrossRef
22.
go back to reference Efthimiou E, Court O, Sampalis J, et al. Validation of obesity surgery mortality risk score in patients undergoing gastric bypass in a Canadian center. Surg Obes Relat Dis. 2009;5:643–7.PubMedCrossRef Efthimiou E, Court O, Sampalis J, et al. Validation of obesity surgery mortality risk score in patients undergoing gastric bypass in a Canadian center. Surg Obes Relat Dis. 2009;5:643–7.PubMedCrossRef
23.
go back to reference Parker M, Loewen M, Sullivan T, et al. Predictors of outcome after obesity surgery in New York state from 1991 to 2003. Surg Endosc. 2007;21:1482–6.PubMedCrossRef Parker M, Loewen M, Sullivan T, et al. Predictors of outcome after obesity surgery in New York state from 1991 to 2003. Surg Endosc. 2007;21:1482–6.PubMedCrossRef
24.
go back to reference Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.PubMed Varela JE, Wilson SE, Nguyen NT. Outcomes of bariatric surgery in the elderly. Am Surg. 2006;72:865–9.PubMed
25.
go back to reference Dunkle-Blatter SE, St Jean MR, Whitehead C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis. 2007;3:163–9. discussion 169–170.PubMedCrossRef Dunkle-Blatter SE, St Jean MR, Whitehead C, et al. Outcomes among elderly bariatric patients at a high-volume center. Surg Obes Relat Dis. 2007;3:163–9. discussion 169–170.PubMedCrossRef
26.
go back to reference Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87:1167–73.PubMedCrossRef Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87:1167–73.PubMedCrossRef
27.
go back to reference Sundbom M, Karlson BM. Low mortality in bariatric surgery 1995 through 2005 in Sweden, in spite of a shift to more complex procedures. Obes Surg. 2009;19:1697–701.PubMedCrossRef Sundbom M, Karlson BM. Low mortality in bariatric surgery 1995 through 2005 in Sweden, in spite of a shift to more complex procedures. Obes Surg. 2009;19:1697–701.PubMedCrossRef
28.
go back to reference Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22:2554–63.PubMedCrossRef Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22:2554–63.PubMedCrossRef
29.
go back to reference Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis. 2007;3:116–26.PubMedCrossRef Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis. 2007;3:116–26.PubMedCrossRef
30.
go back to reference DeMaria EJ, Murr M, Byrne TK, et al. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg. 2007;246:578–82. discussion 583–584.PubMedCrossRef DeMaria EJ, Murr M, Byrne TK, et al. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg. 2007;246:578–82. discussion 583–584.PubMedCrossRef
31.
go back to reference Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246:1002–7. discussion 1007–1009.PubMedCrossRef Morino M, Toppino M, Forestieri P, et al. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246:1002–7. discussion 1007–1009.PubMedCrossRef
32.
go back to reference Goldfeder LB, Ren CJ, Gill JR. Fatal complications of bariatric surgery. Obes Surg. 2006;16:1050–6.PubMedCrossRef Goldfeder LB, Ren CJ, Gill JR. Fatal complications of bariatric surgery. Obes Surg. 2006;16:1050–6.PubMedCrossRef
33.
go back to reference Smith MD, Patterson E, Wahed AS, et al. Relationship between surgeon volume and adverse outcomes after RYGB in longitudinal assessment of bariatric surgery (LABS) study. Surg Obes Relat Dis. 2010;6:118–25.PubMedCrossRef Smith MD, Patterson E, Wahed AS, et al. Relationship between surgeon volume and adverse outcomes after RYGB in longitudinal assessment of bariatric surgery (LABS) study. Surg Obes Relat Dis. 2010;6:118–25.PubMedCrossRef
35.
go back to reference Kermarrec N, Marmuse J-P, Faivre J, et al. High mortality rate for patients requiring intensive care after surgical revision following bariatric surgery. Obes Surg. 2008;18:171–8.PubMedCrossRef Kermarrec N, Marmuse J-P, Faivre J, et al. High mortality rate for patients requiring intensive care after surgical revision following bariatric surgery. Obes Surg. 2008;18:171–8.PubMedCrossRef
36.
go back to reference Szczepaniak LS, Victor RG, Orci L, et al. Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America. Circ Res. 2007;101:759–67.PubMedCrossRef Szczepaniak LS, Victor RG, Orci L, et al. Forgotten but not gone: the rediscovery of fatty heart, the most common unrecognized disease in America. Circ Res. 2007;101:759–67.PubMedCrossRef
37.
go back to reference Poirier P, Alpert MA, Fleisher LA, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009;120:86–95.PubMedCrossRef Poirier P, Alpert MA, Fleisher LA, et al. Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circulation. 2009;120:86–95.PubMedCrossRef
Metadata
Title
Thirty-day Mortality After Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery
Authors
Mark D. Smith
Emma Patterson
Abdus S. Wahed
Steven H. Belle
Paul D. Berk
Anita P. Courcoulas
Gregory F. Dakin
David R. Flum
Laura Machado
James E. Mitchell
John Pender
Alfons Pomp
Walter Pories
Ramesh Ramanathan
Beth Schrope
Myrlene Staten
Akuezunkpa Ude
Bruce M. Wolfe
Publication date
01-11-2011
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 11/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-011-0497-8

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