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12-08-2019 | Diabetes | News | Article

Bariatric surgery linked to late adverse events

medwireNews: People who undergo bariatric surgery have a lower long-term risk for mortality, but a higher risk for adverse events such as gastrointestinal and nutritional disorders, compared with those who do not undergo surgery, researchers report.

Therefore, despite the other “major benefits” of bariatric surgery, including type 2 diabetes remission and sustainable weight loss, these findings highlight “the need to inform patients seeking bariatric surgery that these procedures will require careful preoperative assessment of the benefit–risk balance,” write the study authors in The Lancet Diabetes & Endocrinology.

“Furthermore, patients must be aware that they will have to comply with multidisciplinary careful lifelong follow-up,” they add.

Jérémie Thereaux (Caisse Nationale d’Assurance Maladie, Paris, France) used the French national health insurance database to evaluate long-term outcomes of all 8966 patients who underwent gastric bypass (n=4955) or sleeve gastrectomy (n=4011) in France in 2009 and did not undergo revisional bariatric surgery in the 4 years prior to study entry.

During an average follow-up of 6.8 years, mortality rates were significantly lower among individuals undergoing bariatric surgery compared with 8966 controls matched on age, sex, BMI, and diabetes therapy, at 35.4 versus 60.2 deaths per 10,000 person–years, and a hazard ratio (HR) of 0.64.

Nonetheless, people who underwent gastric bypass or sleeve gastrectomy were significantly more likely than controls to require hospital admission for an invasive gastrointestinal procedure or gastrointestinal, nutritional, or psychiatric disorders.

When the reasons for hospital admission were analyzed separately, people in the gastric bypass and sleeve gastrectomy groups had significantly higher rates of invasive gastrointestinal procedures than their matched controls, with adjusted hazard ratios of 2.31 and 1.62, respectively, on multivariable analysis.

Individuals undergoing gastric bypass or sleeve gastrectomy were also significantly more likely than controls to require hospital admission for other gastrointestinal symptoms (adjusted HR=1.86 and 1.28, respectively), and had a significantly higher risk for nutritional disorders (adjusted HR=4.13 and 1.46, respectively). There was no significant difference in the risk for psychiatric disorders between the groups, however.

Writing in an accompanying comment, Xabier Unamuno (University of Navarra, Pamplona, Spain) and colleagues say that the late adverse events identified in the study are “challenging the benefit–risk balance because bariatric surgery is now proposed to younger patients with a long life expectancy after such procedures.”

They add: “Since unintended consequences and adverse effects of bariatric surgery might appear, it is imperative that these outcomes and health risks are evaluated in a systematic and rigorous way.”

They caution that the database used by Thereaux and team did not include precise information on patients’ weight, meaning that it was not possible to determine “whether part of the complications might be due to obesity or whether complications arose irrespective of weight outcomes.”

And they conclude that “to develop more effective bariatric interventions and improve surgical treatments, novel patient-centred approaches that might focus on subsets of specific populations to avoid long-term adverse effects and mitigate potential unintended consequences are required.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Lancet Diabetes Endocrinol 2019; doi:10.1016/S2213-8587(19)30191-3
Lancet Diabetes Endocrinol 2019; doi:10.1016/S2213-8587(19)30248-7