RT Journal
A1 Schauer DP, Arterburn DE, Livingston EH, Fischer D, Eckman MH
T1 DEcision modeling to estimate the impact of gastric bypass surgery on life expectancy for the treatment of morbid obesity
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD January 1
VO 145
IS 1
SP 57
OP 62
DO 10.1001/archsurg.2009.240
UL http://dx.doi.org/10.1001/archsurg.2009.240
AB Objective 
    To create a decision analytic model to estimate the balance between treatment risks and benefits for patients with morbid obesity.Design 
    Decision analytic Markov state transition model with multiple logistic regression models as inputs. Data from the 2005 National Inpatient Survey were used to calculate in-hospital mortality risk associated with bariatric surgery and then adjusted for 30-day mortality. To calculate excess mortality associated with obesity, we used the 1991-1996 National Health Interview Survey linked to the National Death Index. Bariatric surgery was assumed to influence mortality only through its impact on the excess mortality associated with obesity, and the efficacy of surgery was estimated from a recent large observational trial.Intervention 
    Gastric bypass surgery.Main Outcome Measure 
    Life expectancy.Results 
    Our base case, a 42-year-old woman with a body mass index of 45, gained an additional 2.95 years of life expectancy with bariatric surgery. No surgical treatment was favored in our base case when the 30-day surgical mortality exceeded 9.5% (baseline 30-day mortality, 0.2%) or when the efficacy of bariatric surgery for reducing mortality decreased to 2% or less (baseline efficacy, 53%).Conclusions 
    The optimal decision for individual patients varies based on the balance of risk between perioperative mortality, excess annual mortality risk associated with increasing body mass index, and the efficacy of surgery; however, for the average morbidly obese patient, gastric bypass improves life expectancy.