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David R. Flum, MD, MPH; Leon Salem, MD; Jo Ann Broeckel Elrod, PhD; E. Patchen Dellinger, MD; Allen Cheadle, PhD; Leighton Chan, MD, MPH

JAMA. 2005;294:1903-1908.

Context  Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown.

Objectives  To evaluate the risk of early mortality among Medicare beneficiaries and to determine the relative risk of death among older patients.

Design  Retrospective cohort study.

Setting and Patients  All fee-for-service Medicare beneficiaries, 1997-2002.

Main Outcome Measures  Thirty-day, 90-day, and 1-year postsurgical all-cause mortality among patients undergoing bariatric procedures.

Results  A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged 75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index.

Conclusions  Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients.

Author Affiliations: Departments of Surgery (Drs Flum, Salem, Broeckel Elrod, and Dellinger), Health Services (Drs Flum and Cheadle), and Rehabilitation Medicine (Dr Chan), University of Washington, and the Division of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Region 10 (Dr Chan), Seattle, Wash.

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