Mortality Rates and Causes of Death After Bariatric Surgery in Elderly Patients

Overview

This population-based matched cohort study analyzed mortality and causes of death in patients aged over 60 undergoing metabolic bariatric surgery compared to non-operative obese patients. The study included 3,879 operated patients and 19,395 matched controls from three Nordic countries, revealing low 90-day mortality and differences in cause-specific mortality.

Background

Obesity affects 30–40% of adults in high-income countries and is linked to multiple comorbidities including diabetes, hypertension, cardiovascular disease, and reduced survival. Metabolic bariatric surgery induces significant weight loss and often resolves obesity-related diseases, but its benefits and risks in patients older than 60 years remain controversial. This study aimed to assess long-term mortality and causes of death in elderly patients undergoing bariatric surgery compared to matched non-operated obese patients using nationwide registry data from Denmark, Finland, and Sweden.

Data Highlights

Key Findings

• Among elderly patients (>60 years), metabolic bariatric surgery was associated with a low 90-day mortality rate of 0.6%.
• Operated patients had higher prevalence of diabetes and hypertension but lower prevalence of cardiovascular disease compared to non-operated patients.
• Matching was performed by country, age, sex, and calendar year with up to 5 non-operated controls per operated patient.
• Cause of death registries provided comprehensive data on mortality outcomes across the three Nordic countries.
• Frailty-related diagnoses and previous hospital admissions were similarly distributed between groups, minimizing confounding by frailty.
• Multivariable Cox regression and Laplace regression analyses adjusted for multiple confounders to assess mortality risk and time to death.

Clinical Implications

Metabolic bariatric surgery can be considered a relatively safe and potentially beneficial treatment option for severe obesity in patients over 60 years, with low short-term mortality and potential for improved long-term survival. Careful patient selection and management of comorbidities remain essential to optimize outcomes in this age group.

Conclusion

This large Nordic cohort study demonstrates that metabolic bariatric surgery in elderly patients is associated with low perioperative mortality and provides valuable insights into mortality patterns compared to non-operative obese patients. These findings support the consideration of bariatric surgery as a treatment option in selected older adults with severe obesity.

References

1. Nordic Bariatric Surgery Study Group 2024 -- Mortality Rates and Causes of Death Following Metabolic Bariatric Surgery in Elderly Patients