"Super-obesity" Associated with Risk of Death Among Veterans Following Bariatric Surgery
Currently, 165,000 Veterans who use VA medical facilities have class III obesity, defined as a body mass index (BMI) of 40 or greater, and evidence suggests bariatric surgery is one of the few interventions that can help morbidly obese individuals lose enough weight to significantly improve their health and quality of life. The number of bariatric procedures performed in VA medical facilities more than tripled between 2000 and 2006; however, the surgery is being performed on only about 0.1% of Veterans who meet BMI criteria. This retrospective study of 856 bariatric surgical cases conducted in 12 VAMCs between 2000 and 2006 sought to define the risk of death among this Veteran population – and to identify patient-level factors associated with mortality. Using data from VA’s National Surgical Quality Improvement Program (NSQIP), investigators assessed patient demographics, BMI, and comorbidities, as well as mortality and morbidity. Investigators also assessed Veterans according to their Diagnostic Cost Group (DCG) score. A patient whose predicted expenditures are equal to the Medicare national average has a DCG of 1.0; if the score is higher, the patient is expected to have above-average expenditures, which may be the result of comorbid illness (e.g., diabetes, heart disease).
Findings show that Veterans classified as “super-obese” (BMI of 50 or higher) and those with a higher chronic disease burden appear more likely to die within one year of having bariatric surgery. Overall, 30-day, 90-day, and 1-year mortality rates were 1.3%, 2.1%, and 3.4%, respectively, compared to super-obese Veterans (36% of sample) at 2%, 3.6% and 5.2%, respectively. Veterans with a DCG >2 had even higher mortality rates of 1.5%, 5.8% and 10.1%, respectively. The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery. Authors recommend that the risks of bariatric surgery in patients with significant comorbidities should be carefully weighed against potential benefits in older male Veterans and those with super-obesity.
Arterburn D, Livingston E, Schifftner T, Kahwati L, Henderson W, and Maciejewski M. Predictors of long-term mortality following bariatric surgery in Veterans Affairs Medical Centers. Archives of Surgery October 2009;144(10):914-920.
This study was funded by HSR&D. Dr. Maciejewski is part of HSR&D’s Center for Health Services Research in Primary Care in Durham, NC.