title: Long-term mortality rates (>8-year) improve as compared to the general and obese population following bariatric surgery.
abstract: BACKGROUND
  Sparse data are available on long-term patient mortality following bariatric surgery as compared to the general population. The purpose of this study was to assess long-term mortality rates and identify risk factors for all-cause mortality following bariatric surgery.
  
  
  METHODS
  New York State (NYS) Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 7,862 adult patients who underwent a primary laparoscopic bariatric surgery from 1999 to 2005. The Social Security Death Index database identified >30-day mortalities. Risk factors for mortality were screened using a univariate Cox proportional hazard (PH) model and analyzed using a multiple PH model. Based on age, gender, and race/ethnicity, actuarial projections for NYS mortality rates obtained from Centers of Disease Control were compared to the actual post-bariatric surgery mortality rates observed.
  
  
  RESULTS
  The mean bariatric mortality rate was 2.5 % with 8-14 years of follow-up. Mean time to death ranged from 4 to 6 year and did not differ by operation (p = 0.073). From 1999 to 2010, the actuarial mortality rate predicted for the general NYS population was 2.1 % versus the observed 1.5 % for the bariatric surgery population (p = 0.005). Extrapolating to 2013, demonstrated the actuarial mortality predictions at 3.1 % versus the bariatric surgery patients' observed morality rate of 2.5 % (p = 0.01). Risk factors associated with an earlier time to death included: age, male gender, Medicare/Medicaid insurance, congestive heart failure, rheumatoid arthritis, pulmonary circulation disorders, and diabetes. No procedure-specific or perioperative complication impact for time-to-death was found.
  
  
  CONCLUSIONS
  Long-term mortality rate of patients undergoing bariatric surgery significantly improves as compared to the general population regardless of bariatric operation performed. Additionally, perioperative complications do not increase long-term mortality risk. This study did identify specific patient risk factors for long-term mortality. Special attention and consideration should be given to these "at risk" patient sub-populations.
authors.affiliation: Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA, dana.telem@stonybrookmedicine.edu.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.forename: A Laurie
authors.initials: AL
authors.lastname: Shroyer
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Maria
authors.initials: M
authors.lastname: Altieri
authors.forename: Qiao
authors.initials: Q
authors.lastname: Zhang
authors.forename: Gerald
authors.initials: G
authors.lastname: Gracia
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000401:mortality*; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors