Bariatric Surgery Study Looks at Survival Impact in Older Veterans
July 7, 2011
WASHINGTON (July 07, 2011) - In the first study to compare survival
associated with bariatric surgery in mostly male patients, bariatric
surgery was not significantly associated with decreased mortality,
according to a research study published in the June 15 issue of the
Journal of the American Medical Association.
"At VA, we are committed to delivering the best care possible to
said Secretary of Veterans Affairs Eric K. Shinseki. "VA's research
program plays an invaluable role by continually evaluating available
approaches to determine their benefits and risks in different
In recent years, there has been a substantial increase in the prevalence
of obesity, which is a challenge to treat. Bariatric surgery is the most
effective way for severely obese patients to achieve weight loss.
The bariatric surgery study compared mortality rates for 850 obese
Veterans who had received the procedure at one of 12 VA bariatric
surgery centers between 2000 and 2006. These Veterans were considered to
be "high-risk" due to older age and greater weight in comparison to more
than 41,000 obese Veterans who had not received bariatric surgery, but
had used VA outpatient services. The study also compared mortality rates
for 847 obese Veterans who had received bariatric surgery and 847
matched obese Veterans who had not received bariatric surgery. Patients
were followed for nearly 7 years.
"By evaluating one important treatment option for obesity, this study
represents another significant advance in defining best care approaches
for those who entrust their health to VA," said Dr. Robert A. Petzel,
VA's Under Secretary for Health.
The study was designed to shed light on the benefits of bariatric
surgery in a defined group of patients over a limited timeframe. Despite
this study's findings, study investigators are not suggesting VA stop
doing bariatric surgery for certain patients.
"Significant weight loss results in improved disease control and quality
of life for patients, so there are many reasons why patients like those
in our study may still want to undergo bariatric surgery," said Dr.
Matthew Maciejewski, the study's lead investigator and part of the
Health Services Research and Development Center for Health Services
Research in Durham, N.C. " Also, other studies, conducted on different
patient populations, have found bariatric surgery to be associated with
reduced mortality and have also suggested that survival benefits from
surgery-induced weight loss may take longer than six years to become
An analysis of the 1,694 propensity-matched patients found that
bariatric surgery was not significantly associated with reduced
mortality. Maciejewski recommends that Veterans who are considering
bariatric surgery in VA, and who are similar to Veterans examined in
this study, "should be counseled by their VA surgeon that bariatric
surgery may not impact their survival in the medium term (6-7 years),
but that the long-term association with mortality remains unknown."
Moreover, because a high proportion of Veterans with diabetes or high
cholesterol are able to discontinue their medications after bariatric
surgery, he suggests that longer-term survival benefits be examined for
Veterans who had bariatric surgery after 2006, before VA changes its
policy and/or guidelines.
Dr. Joel Kupersmith, VA's Chief Research and Development Officer, notes
that VA considers all associated evidence in any policy decision, but
notes this is just one study. "It is by conducting leading-edge research
studies such as this one on bariatric surgery, and evaluating the
meaning in the context of all rigorous scientific evidence, that VA
Research provides the foundation for optimal Veterans' health care," he
Dr. Maciejewski also does not recommend that insurers stop covering
bariatric surgery for high-risk patients based on these study results
because, "survival is just one aspect of the cost-effectiveness of
bariatric surgery, which has been shown to be cost-effective for