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.
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 obesepatient, gastric bypass improves life expectancy.
Authors: Edward H Livingston; Sergio Huerta; Denice Arthur; Scott Lee; Scott De Shields; David Heber Journal: Ann Surg Date: 2002-11 Impact factor: 12.969
Authors: Melinda A Maggard; Lisa R Shugarman; Marika Suttorp; Margaret Maglione; Harvey J Sugerman; Harvey J Sugarman; Edward H Livingston; Ninh T Nguyen; Zhaoping Li; Walter A Mojica; Lara Hilton; Shannon Rhodes; Sally C Morton; Paul G Shekelle Journal: Ann Intern Med Date: 2005-04-05 Impact factor: 25.391
Authors: Zhaoping Li; Margaret Maglione; Wenli Tu; Walter Mojica; David Arterburn; Lisa R Shugarman; Lara Hilton; Marika Suttorp; Vanessa Solomon; Paul G Shekelle; Sally C Morton Journal: Ann Intern Med Date: 2005-04-05 Impact factor: 25.391
Authors: Allison A Hedley; Cynthia L Ogden; Clifford L Johnson; Margaret D Carroll; Lester R Curtin; Katherine M Flegal Journal: JAMA Date: 2004-06-16 Impact factor: 56.272
Authors: Kathleen M McTigue; Russell Harris; Brian Hemphill; Linda Lux; Sonya Sutton; Audrina J Bunton; Kathleen N Lohr Journal: Ann Intern Med Date: 2003-12-02 Impact factor: 25.391
Authors: Daniel P Schauer; David E Arterburn; Edward H Livingston; Karen J Coleman; Steve Sidney; David Fisher; Patrick OʼConnor; David Fischer; Mark H Eckman Journal: Ann Surg Date: 2015-05 Impact factor: 12.969
Authors: Daniel P Schauer; David E Arterburn; Ruth Wise; William Boone; David Fischer; Mark H Eckman Journal: Surg Obes Relat Dis Date: 2013-09-30 Impact factor: 4.734
Authors: David E Arterburn; Andy Bogart; Nancy E Sherwood; Stephen Sidney; Karen J Coleman; Sebastien Haneuse; Patrick J O'Connor; Mary Kay Theis; Guilherme M Campos; David McCulloch; Joe Selby Journal: Obes Surg Date: 2013-01 Impact factor: 4.129
Authors: Bruce C M Wang; Edwin S Wong; Rafael Alfonso-Cristancho; Hao He; David R Flum; David E Arterburn; Louis P Garrison; Sean D Sullivan Journal: Eur J Health Econ Date: 2013-03-24
Authors: Eliza A Conaty; Woody Denham; Stephen P Haggerty; John G Linn; Raymond J Joehl; Michael B Ujiki Journal: Obes Surg Date: 2020-02 Impact factor: 4.129