University of Oulu

Joonas H. Kauppila, Wenjing Tao, Giola Santoni, My von Euler-Chelpin, Elsebeth Lynge, Laufey Tryggvadóttir, Eivind Ness-Jensen, Pål Romundstad, Eero Pukkala, Jesper Lagergren, Effects of Obesity Surgery on Overall and Disease-Specific Mortality in a 5-Country Population-Based Study, Gastroenterology, Volume 157, Issue 1, 2019, Pages 119-127.e1, ISSN 0016-5085,

Effects of obesity surgery on overall and disease-specific mortality in a 5-country population-based study

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Author: Kauppila, Joonas H.1,2; Tao, Wenjing1; Santoni, Giola1;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
3Department of Public Health, University of Copenhagen, Denmark
4Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
5Faculty of Medicine, Laeknagardur, University of Iceland, Reykjavik, Iceland
6Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
7Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
8Faculty of Social Sciences, University of Tampere, Tampere, Finland
9School of Cancer and Pharmaceutical Sciences, King’s College London and Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Elsevier, 2019
Publish Date: 2020-03-30


Background & Aims: Bariatric surgery might reduce overall mortality from obesity. We investigated whether the survival times of patients who have had bariatric surgery are similar to those of the general population and are longer than of obese individuals who did not receive surgery.

Methods: We performed a population-based cohort study of persons with a diagnosis of obesity listed in nationwide registries from Nordic countries from 1980 through 2012. Bariatric surgery was analyzed in relation to all-cause mortality and the obesity-related morbidities cardiovascular disease, diabetes, cancer, and suicide. Poisson models provided standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). Multivariable Cox regression provided hazard ratios (HRs) for mortality in participants who did and did not have surgery.

Results: Among 505,258 participants, 49,977 had bariatric surgery. Overall all-cause SMR was increased after surgery (1.94; 95% CI, 1.83–2.05) and increased with longer follow-up, to 2.28 (95% CI, 2.07–2.51) at ≥15 years after surgery. SMRs were increased for cardiovascular disease (2.39; 95% CI, 2.17–2.63), diabetes (3.67; 95% CI, 2.85–4.72), and suicide (2.39; 95% CI, 1.96–2.92) but not for cancer (1.05; 95% CI, 0.95–1.17); SMRs increased with time. In obese participants who did not have surgery, all-cause SMR was 2.15 (95% CI, 2.11–2.20), which remained stable during follow-up. Compared with obese participants who did not have surgery, patients who had bariatric surgery had decreased overall mortality from all causes (HR, 0.63; 95% CI, 0.60–0.66), cardiovascular disease (HR, 0.57; 95% CI, 0.52–0.63), and diabetes (HR, 0.38; 95% CI, 0.29–0.49) but increased mortality from suicide (HR, 1.68; 95% CI, 1.32–2.14). Cancer mortality was decreased overall (HR, 0.84; 95% CI, 0.76–0.93) but increased at ≥15 years of follow-up (HR, 1.20; 95% CI, 1.02–1.42).

Conclusions: In a study of persons with a diagnosis of obesity listed in nationwide registries of Nordic countries, we found that obese patients who have bariatric surgery have longer survival times than obese individuals who did not have bariatric surgery, but their mortality is higher than that of the general population and increases with time. Obesity-related morbidities could account for these findings.

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Series: Gastroenterology
ISSN: 0016-5085
ISSN-E: 1528-0012
ISSN-L: 0016-5085
Volume: 157
Issue: 1
Pages: 119 - 127
DOI: 10.1053/j.gastro.2019.03.048
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by research grants from the Swedish Research Council SIMSAM (D0547801), Nordic Cancer Union (154860), and Swedish Cancer Society (140322).
Copyright information: © 2019 by the AGA Institute. Published by Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license