Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants
| Autor: | Guowei Kim, David E. Cummings, Marie Loh, Daryl J. Lin, Claire Alexandra Zhen Chew, Jimmy Bok Yan So, Ying Ern Loo, John B. Dixon, Zong Jie Koh, Joseph J. Zhao, Nicholas Syn, Bee Choo Tai, Lee M. Kaplan, Asim Shabbir, Louis Zizhao Wang |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Population Bariatric Surgery 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences Life Expectancy 0302 clinical medicine Cause of Death medicine Humans Obesity Prospective Studies 030212 general & internal medicine Mortality education Prospective cohort study Survival rate Proportional Hazards Models Randomized Controlled Trials as Topic education.field_of_study business.industry Mortality rate Hazard ratio Case-control study General Medicine Surgery Survival Rate Diabetes Mellitus Type 2 Case-Control Studies Number needed to treat Controlled Clinical Trials as Topic business Cohort study |
| Zdroj: | The Lancet. 397:1830-1841 |
| ISSN: | 0140-6736 |
| DOI: | 10.1016/s0140-6736(21)00591-2 |
| Popis: | Metabolic-bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy-especially stratified by pre-existing diabetes status-are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic-bariatric surgery versus usual care.We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic-bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic-bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472.Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic-bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3-51·9, p0·0001) and median life expectancy was 6·1 years (95% CI 5·2-6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370-0·453, p0·0001) or without (0·704, 0·588-0·843, p0·0001) baseline diabetes who underwent metabolic-bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup IAmong adults with obesity, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without.None. |
| Databáze: | OpenAIRE |
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