Gastric bypass pros and cons reported for type 2 diabetes patients
medwireNews: Overweight and obese patients with type 2 diabetes who undergo gastric bypass have significantly lower risks for death, cardiovascular disease (CVD), and severe kidney disease than those who do not have such surgery, Swedish research shows.
They are also at significantly increased risk for both short- and long-term complications, however.
Vasileios Liakopoulos (University of Gothenburg) and colleagues report that during an average follow-up of 4.5 years, the risk for all-cause mortality was a significant 49% lower among 5321 patients with type 2 diabetes who underwent Roux-en-Y gastric bypass than among 5321 patients who also had type 2 diabetes and were matched for sex, age, BMI, and time period, but did not undergo surgery.
The incidence rates for all-cause mortality were 72.9 and 142.1 per 10,000 person–years in the gastric bypass and control groups, respectively.
Patients who underwent surgery also had a significant 42% lower risk for severe kidney disease (42.4 vs 76.9 events per 10,000 person–years) and a 34% lower risk for CVD (43.5 vs 61.5 events per 10,000 person–years), as well as significantly lower risks for hospitalization for hyperglycemia (hazard ratio [HR]=0.33), leg amputation (HR=0.51), and cancer (HR=0.78).
The disadvantages of gastric bypass included a significant 3.3-fold higher risk for additional gastric surgery, likely due to the higher risks for bowel obstruction (HR=9.5), bleeding (HR=6.9), abdominal pain (HR=5.5), gastrointestinal leakage (HR=5.5), and gastrointestinal ulcers and reflux (HR=5.4), as well as wound complications (HR=3.5), hernia (HR=2.8) and gallstones, gallbladder disease, or pancreatitis (HR=2.5).
In the long term, patients who underwent gastric bypass had significant 2.8- and 1.9-fold higher risks for malnutrition and anemia, respectively, and also a 1.3-fold higher risk for hospitalization for psychiatric disorders.
This particular finding indicates that “greater awareness is needed in order to identify vulnerable patients with a history of self-harm or depression who may need psychiatric services after [gastric bypass],” Liakopoulos et al remark.
They also note that, in line with previous data, patients who underwent gastric bypass were at significantly higher risk for alcohol-related problems that lead to hospitalization than those who did not, at an HR of 2.9, which the team says highlights “the importance of careful selection of patients who are offered surgery, as well as better follow-up of those with a history of alcohol-related risk behaviour.”
Writing in BMJ Open, Liakopoulos and co-authors point out that their study only included events that were diagnosed during hospitalization, not outpatient care. “Comorbidities and incidence of postoperative outcomes may be underestimated as a result,” they say.
The researchers conclude that “to maximise the benefit and minimise the risk of problems [associated with gastric bypass], long-term postoperative monitoring and support should be provided.”
They add: “Better selection of patients for such treatment, performed by appropriate specialists in interdisciplinary settings, could probably also optimise outcomes.”
By Laura Cowen
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