Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: Nationwide, matched, observational cohort study

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Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: Nationwide, matched, observational cohort study

Liakopoulos, Vasileios (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Medical Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden

Franzén, Stefan, 1967 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Extern,Institute of Medicine, Department of Molecular and Clinical Medicine,External,National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden; Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Svensson, Ann-Marie, 1961 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Extern,Institute of Medicine, Department of Molecular and Clinical Medicine,External,Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden

Miftaraj, Mervete, 1970 (author): National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden

Ottosson, Johan, 1957- (author): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Surgery

Näslund, Ingmar (author): Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Gudbjörnsdottir, Soffia, 1962 (author): Gothenburg University,Göteborgs universitet,Extern,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,External,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Institute of Medicine, Department of Molecular and Clinical Medicine,Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden

Eliasson, Björn, 1959 (author): Gothenburg University,Göteborgs universitet,Extern,Wallenberglaboratoriet,Institutionen för medicin,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,External,Wallenberg Laboratory,Institute of Medicine,Institute of Medicine, Department of Molecular and Clinical Medicine,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Medical Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden

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2019-01-15
2019
English.
In: BMJ Open. - : BMJ. - 2044-6055. ; 9:1

Related links:: https://bmjopen.bmj....; show more...; https://doi.org/10.1...; https://gup.ub.gu.se...; https://doi.org/10.1...; https://urn.kb.se/re...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

© Author(s) (or their employer(s)) 2019. Objectives: Long-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications. Design: This is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases. Setting: After merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models. Participants: We identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18-65 years, with BMI >27.5 kg/m 2 ; and followed for up to 9 years. Primary and secondary outcome measures: We assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions. Results: The results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group. Conclusions: This nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

adverse effects
bariatric surgery
diabetes mellitus
obesity
postoperative complications

Publication and Content Type

ref (subject category)
art (subject category)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Endocrinology an ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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