All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers

Laura J. Rasmussen-Torvik*, Orna Reges, Philip Greenland, Dror Dicker, Morton Leibowitz, Adi Berliner Senderey, Moshe Hoshen, Ran D. Balicer

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers. Materials and Methods: We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders. Results: There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54–2.56) and non-smoking (HR, 1.93; 95% CI, 1.12–3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction =.67). Conclusions: Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.

Original languageEnglish (US)
Pages (from-to)3854-3859
Number of pages6
JournalObesity Surgery
Volume29
Issue number12
DOIs
StatePublished - Dec 1 2019

Fingerprint

Bariatric Surgery
Mortality
Smoking
Gastric Bypass
Electronic Health Records
Lost to Follow-Up
Gastrectomy
Health Personnel
Stomach
Cohort Studies
Retrospective Studies
Organizations

Keywords

  • Bariatric surgery
  • Gastric banding
  • Mortality
  • Roux-en-Y gastric bypass
  • Sleeve gastrectomy
  • Subgroups

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Rasmussen-Torvik, Laura J. ; Reges, Orna ; Greenland, Philip ; Dicker, Dror ; Leibowitz, Morton ; Senderey, Adi Berliner ; Hoshen, Moshe ; Balicer, Ran D. / All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers. In: Obesity Surgery. 2019 ; Vol. 29, No. 12. pp. 3854-3859.
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title = "All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers",
abstract = "Introduction: Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers. Materials and Methods: We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1{\%} lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders. Results: There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95{\%} CI, 1.54–2.56) and non-smoking (HR, 1.93; 95{\%} CI, 1.12–3.34) subgroups. Although smokers had higher rates of mortality overall (2.6{\%} in smokers compared with 1.7{\%} in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction =.67). Conclusions: Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.",
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Rasmussen-Torvik, LJ, Reges, O, Greenland, P, Dicker, D, Leibowitz, M, Senderey, AB, Hoshen, M & Balicer, RD 2019, 'All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers', Obesity Surgery, vol. 29, no. 12, pp. 3854-3859. https://doi.org/10.1007/s11695-019-04055-4

All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers. / Rasmussen-Torvik, Laura J.; Reges, Orna; Greenland, Philip; Dicker, Dror; Leibowitz, Morton; Senderey, Adi Berliner; Hoshen, Moshe; Balicer, Ran D.

In: Obesity Surgery, Vol. 29, No. 12, 01.12.2019, p. 3854-3859.

Research output: Contribution to journalArticle

TY - JOUR

T1 - All-Cause Mortality Following Bariatric Surgery in Smokers and Non-smokers

AU - Rasmussen-Torvik, Laura J.

AU - Reges, Orna

AU - Greenland, Philip

AU - Dicker, Dror

AU - Leibowitz, Morton

AU - Senderey, Adi Berliner

AU - Hoshen, Moshe

AU - Balicer, Ran D.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Introduction: Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers. Materials and Methods: We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders. Results: There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54–2.56) and non-smoking (HR, 1.93; 95% CI, 1.12–3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction =.67). Conclusions: Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.

AB - Introduction: Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers. Materials and Methods: We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders. Results: There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54–2.56) and non-smoking (HR, 1.93; 95% CI, 1.12–3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction =.67). Conclusions: Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.

KW - Bariatric surgery

KW - Gastric banding

KW - Mortality

KW - Roux-en-Y gastric bypass

KW - Sleeve gastrectomy

KW - Subgroups

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