Higher Mortality for Men After Bariatric Surgery?

A Good Glass of BeerBariatric surgery is a relatively safe surgical procedure. Overall, people with obesity who undergo bariatric surgery tend to live longer than those who don’t. Nonetheless, just as with any surgery, complications can occur. Recent data from the MBSAQIP database document a 30-day mortality rate between one and two deaths per thousand patients. New data, presented at the EASD annual meeting last week, suggests that this rate might be substantially higher for men than women.

In fact, Hannes Beiglböck and colleagues found a five fold higher mortality rate for men than women in their observational study. The key question is why and the answer may be that men are delaying surgery until they present with riskier profiles.

An Analysis of 19,901 Cases from Austria

Beiglböck’s study was based on medical records from the Austrian state insurance system, which covers roughly 98 percent of the Austrian population. Of the 19,901 patients who had bariatric surgery, 14,681 were women. This is fairly typical, because men seek bariatric surgery much less often than women. Research suggests that many factors conspire to make this so.

According to Beiglböck these differences in how often men and women seek surgery may explain the differences in mortality they observed:

“Surgical procedures are some of the most successful ways to help people with extreme obesity to lose weight, but they can come with complications. Although the absolute risk of dying after bariatric surgery is low, the findings of our large nationwide study highlight a substantially increased mortality risk among men compared to women. Women seem more willing to look at surgical weight loss earlier in life, whereas men tend to wait until they have more comorbidities.”

Delay and Avoidance of Care Ends Badly

Many factors enter into the phenomenon of delayed care for people who need bariatric surgery. Some are cultural. Others relate to difficulties with health insurance. But in any event, we know that care delayed can mean care denied.

Obesity is a chronic, progressive disease. As it progresses without treatment, it leads to other diseases and chips away at a person’s life expectancy. This study gives a hint about the possibility of worse outcomes for men undergoing bariatric surgery. It does not give the final answer because more research is necessary. But this seems to be a story of an unhappy ending for delays in seeking needed care.

Click here for the study presented at EASD, here, here, and here for further perspective. For an analysis of the disparities in bariatric surgery between men and women, click here.

A Good Glass of Beer, painting by Edouard Manet / WikiArt

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October 5, 2021