Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May;261(5):914-9.
doi: 10.1097/SLA.0000000000000907.

Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: a decision analysis

Daniel P Schauer  1 , David E Arterburn, Edward H Livingston, Karen J Coleman, Steve Sidney, David Fisher, Patrick OʼConnor, David Fischer, Mark H Eckman
Affiliations

Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: a decision analysis

Daniel P Schauer et al. Ann Surg. 2015 May.

Abstract

Objective: To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes.

Background: Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified.

Methods: We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients. The model is informed by data from 3 large cohorts: (1) 159,000 severely obese diabetic patients (4185 had bariatric surgery) from 3 HMO Research Network sites; (2) 23,000 subjects from the Nationwide Inpatient Sample; and (3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index.

Results: In our main analyses, we found that a 45-year-old woman with diabetes and a body mass index (BMI) of 45 kg/m gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs 31.7 years without surgery). Sensitivity analyses revealed that the gain in life expectancy decreased with increasing BMI, until a BMI of 62 kg/m is reached, at which point nonsurgical treatment was associated with greater life expectancy. Similar results were seen for both men and women in all age groups.

Conclusions: For most severely obese patients with diabetes, bariatric surgery seems to improve life expectancy; however, surgery may reduce life expectancy for the super obese with BMIs over 62 kg/m.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interests: No conflicts of interest to declare.

Figures

Figure 1
Figure 1
Hazard ratios for death following bariatric surgery by time interval compared with non-surgical treatment. The fully adjusted Cox proportional hazards model are the dark lines. The light gray lines are for the matched analysis. In both models, the hazard ratios are below one for lower BMIs and go up as the BMI goes up.
Figure 2
Figure 2
Changes in life expectancy by BMI for 3 different age groups of patients. The benefit of gastric bypass decreases as the BMI increases for all age groups for both women and men.
Figure 3
Figure 3
Probabilistic sensitivity analysis for a 45 year-old woman across a range of BMIs.
See this image and copyright information in PMC

Comment in

References

    1. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011; 2011. Centers for Disease Control and Prevention.
    1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009-2010. Hyattsville, MD; National Center for Health Statistics; 2012. NCHS data brief, no 82.
    1. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–9. - PubMed
    1. Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009:CD003641. - PubMed
    1. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56. e5. - PubMed

Publication types