Invited Critique |

Possible Lack of Survival Advantage for One Group:  Comment on “Predictors of Long-term Mortality After Bariatric Surgery Performed in Veterans Affairs Medical Centers”

Clifford W. Deveney, MD
Arch Surg. 2009;144(10):920. doi:10.1001/archsurg.2009.135.
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In their article, “Predictors of Long-term Mortality After Bariatric Surgery Performed in Veterans Affairs Medical Centers,” Arterburn et al make several salient conclusions. The first and most important point is that the postoperative mortality rate between 30 days and 1 year is higher than the 30-day postoperative mortality rate. The second point is that patients with a BMI greater than 50 and a diagnostic cost group score of greater than 2 were at increased risk for mortality at any point up to the year in which they were studied and that 25% of these patients died within the first 3.5 years of follow-up. In their unadjusted data, the authors found that male sex, older age, and higher American Society of Anesthesiologists classification also correlated with a higher risk of death in the first year after gastric bypass. These data are important because they correlate with data of other series that concern risk of death during the first year after gastric bypass.13 The mortality rate in this series, which is slightly higher than the national average, reflects many of the factors that contribute to increased mortality (ie, male, older, increased comorbidities).

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