University of Oulu

Kauppila, J., Santoni, G., Tao, W., Lynge, E., Koivukangas, V., Tryggvadóttir, L., Ness-Jensen, E., Romundstad, P., Pukkala, E., von Euler-Chelpin, M., Lagergren, J. (2020) Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study. British journal of surgery, 107 (9), 1221-1230. doi:10.1002/bjs.11533

Reintervention or mortality within 90 days of bariatric surgery : population‐based cohort study

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Author: Kauppila, J. H.1,2; Santoni, G.1; Tao, W.1;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Surgery Research Unit, Medical Research Centre Oulu, University of Oulu and Oulu University Hospital, Oulu
3Department of Public Health, University of Copenhagen, Denmark
4Icelandic Cancer Registry, Icelandic Cancer Society
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
8Faculty of Social Sciences, Tampere University, Tampere, Finland
9School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 23.9 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2020
Publish Date: 2020-10-30


Background: Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study.

Methods: This population‐based cohort study included all patients who underwent bariatric surgery in one of the five Nordic countries between 1980 and 2012. Data on surgical and endoscopic procedures, diagnoses and mortality were retrieved from national high‐quality and complete registries. Multivariable Cox regression analysis was used to calculate hazard ratios (HRs), adjusted for country, age, sex, co‐morbidity, type of surgery and approach, year and hospital volume of bariatric surgery.

Results: Of 49 977 patients, 1111 (2·2 per cent) had a reintervention and 95 (0·2 per cent) died within 90 days of bariatric surgery. Risk factors for the composite outcome reintervention/mortality were older age (HR 1·65, 95 per cent c.i. 1·36 to 2·01, for age at least 50 years versus less than 30 years) and co‐morbidity (HR 2·66, 1·53 to 4·62, for Charlson co‐morbidity index score 2 or more versus 0). The risk of reintervention/mortality was decreased for vertical banded gastroplasty compared with gastric bypass (HR 0·37, 0·28 to 0·48) and more recent surgery (HR 0·51, 0·39 to 0·67, for procedures undertaken in 2010 or later versus before 2000). Sex, surgical approach (laparoscopic versus open) and hospital volume did not influence risk of reintervention/mortality, but laparoscopic surgery was associated with a lower risk of 90‐day mortality (HR 0·29, 0·16 to 0·53).

Conclusion: Reintervention and death were uncommon events within 90 days of bariatric surgery even in this unselected nationwide cohort from five countries. Older patients with co‐morbidities have an increased relative risk of these outcomes.

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Series: British journal of surgery
ISSN: 0007-1323
ISSN-E: 1365-2168
ISSN-L: 0007-1323
Volume: 107
Issue: 9
Pages: 1221 - 1230
DOI: 10.1002/bjs.11533
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This work was supported by research grants from the Vetenskapsrådet (D0547801), Nordic Cancer Union (154860) and Swedish Cancer Society (140322). The funding entities had no role in the design of the study, data collection, analysis or interpretation of the results, writing of the manuscript or the decision to submit the manuscript for publication. The data will not be made available publicly, but are available upon request from the authors. The research was not preregistered in an institutional registry.
Copyright information: © 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.