BACKGROUND: The optimal BMI threshold above which gastric bypass surgery should be offered to obese patients is controversial. The objective of this study was to compare the impact of Roux-en-Y gastric bypass (RYGB) vs. diet and exercise (D&E) on life expectancy to find the BMI at which patients experience an improvement in their life expectancy by undergoing surgery. METHODS: A Markov state transition model was designed to implement a decision tree that simulated the lives of obese patients. Life expectancies following RYGB and 2 years of D&E were estimated and compared. Ten thousand patients' lives were simulated in each weight-loss intervention group in the model. In addition to base case analysis (45 kg/m(2) BMI pre-intervention), sensitivity analysis of initial BMI at the start of the study was completed. Markov model parameters were extracted from the literature. RESULTS: The impact of RYGB on survival relative to D&E depended on the patient's initial BMI. Compared to patients who underwent 2 years of "optimal" diet and exercise (7 % total body weight loss/year), RYGB improved long-term survival for patients above a BMI of 31.3 kg/m(2). CONCLUSIONS: Roux-en-Y gastric bypass can improve long-term survival for patients with class I obesity. This study suggests that RYGB should not be reserved solely for patients with class II or III obesity.
BACKGROUND: The optimal BMI threshold above which gastric bypass surgery should be offered to obesepatients is controversial. The objective of this study was to compare the impact of Roux-en-Y gastric bypass (RYGB) vs. diet and exercise (D&E) on life expectancy to find the BMI at which patients experience an improvement in their life expectancy by undergoing surgery. METHODS: A Markov state transition model was designed to implement a decision tree that simulated the lives of obesepatients. Life expectancies following RYGB and 2 years of D&E were estimated and compared. Ten thousand patients' lives were simulated in each weight-loss intervention group in the model. In addition to base case analysis (45 kg/m(2) BMI pre-intervention), sensitivity analysis of initial BMI at the start of the study was completed. Markov model parameters were extracted from the literature. RESULTS: The impact of RYGB on survival relative to D&E depended on the patient's initial BMI. Compared to patients who underwent 2 years of "optimal" diet and exercise (7 % total body weight loss/year), RYGB improved long-term survival for patients above a BMI of 31.3 kg/m(2). CONCLUSIONS: Roux-en-Y gastric bypass can improve long-term survival for patients with class I obesity. This study suggests that RYGB should not be reserved solely for patients with class II or III obesity.
Authors: Federico J Serrot; Robert B Dorman; Christopher J Miller; Bridget Slusarek; Barbara Sampson; Brian T Sick; Daniel B Leslie; Henry Buchwald; Sayeed Ikramuddin Journal: Surgery Date: 2011-10 Impact factor: 3.982
Authors: Amy Berrington de Gonzalez; Patricia Hartge; James R Cerhan; Alan J Flint; Lindsay Hannan; Robert J MacInnis; Steven C Moore; Geoffrey S Tobias; Hoda Anton-Culver; Laura Beane Freeman; W Lawrence Beeson; Sandra L Clipp; Dallas R English; Aaron R Folsom; D Michal Freedman; Graham Giles; Niclas Hakansson; Katherine D Henderson; Judith Hoffman-Bolton; Jane A Hoppin; Karen L Koenig; I-Min Lee; Martha S Linet; Yikyung Park; Gaia Pocobelli; Arthur Schatzkin; Howard D Sesso; Elisabete Weiderpass; Bradley J Willcox; Alicja Wolk; Anne Zeleniuch-Jacquotte; Walter C Willett; Michael J Thun Journal: N Engl J Med Date: 2010-12-02 Impact factor: 91.245
Authors: Daniéla Oliveira Magro; Bruno Geloneze; Regis Delfini; Bruna Contini Pareja; Francisco Callejas; José Carlos Pareja Journal: Obes Surg Date: 2008-04-08 Impact factor: 4.129
Authors: Daphne P Guh; Wei Zhang; Nick Bansback; Zubin Amarsi; C Laird Birmingham; Aslam H Anis Journal: BMC Public Health Date: 2009-03-25 Impact factor: 3.295
Authors: Rashikh A Choudhury; Gerard Hoeltzel; Kas Prins; Eric Chow; Hunter B Moore; Peter J Lawson; Dor Yoeli; Akshay Pratap; Peter L Abt; Kristoffel R Dumon; Kendra D Conzen; Trevor L Nydam Journal: J Gastrointest Surg Date: 2019-05-01 Impact factor: 3.452
Authors: Rashikh Choudhury; Christopher D Barrett; Hunter B Moore; Ernest E Moore; Robert C McIntyre; Peter K Moore; Daniel S Talmor; Trevor L Nydam; Michael B Yaffe Journal: World J Emerg Surg Date: 2020-04-20 Impact factor: 5.469