Laura J Rasmussen-Torvik1,2, Orna Reges3,4, Philip Greenland5,6, Dror Dicker7,8, Morton Leibowitz3, Adi Berliner Senderey3, Moshe Hoshen3, Ran D Balicer3,9. 1. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. ljrtorvik@northwestern.edu. 2. Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. ljrtorvik@northwestern.edu. 3. Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel. 4. Department of Health Systems Management, Ariel University, Ariel, Israel. 5. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. 6. Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. 7. Internal Medicine Department D and EASO Collaborating Center for Obesity Management, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel. 8. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 9. Department of Epidemiology, Ben Gurion University of the Negev, Beer Sheva, Israel.
Abstract
INTRODUCTION: Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers. MATERIALS AND METHODS: We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders. RESULTS: There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54-2.56) and non-smoking (HR, 1.93; 95% CI, 1.12-3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction = .67). CONCLUSIONS: Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.
INTRODUCTION: Bariatric surgery is associated with lower all-cause mortality, but many studies exclude smokers. We sought to determine if the association of mortality and bariatric surgery differs between smokers and non-smokers. MATERIALS AND METHODS: We conducted a retrospective cohort study in a large Israeli integrated payer/provider health care organization. A total of 7747 adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with non-surgical patients (and were matched on age, sex, diabetes, and BMI using a sequential/simultaneous stratification matching). A total of 30,742 patients with a median follow-up of 4.3 years were included in this study with less than 1% lost to follow-up. The type of bariatric surgery (gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy) and smoking status were determined from electronic health records. The rate of all-cause mortality in matched surgical and non-surgical patients was compared in smoking and non-smoking subgroups, adjusted for key potential confounders. RESULTS: There was a statistically significantly higher mortality associated with not having bariatric surgery in both smoking (HR, 1.99; 95% CI, 1.54-2.56) and non-smoking (HR, 1.93; 95% CI, 1.12-3.34) subgroups. Although smokers had higher rates of mortality overall (2.6% in smokers compared with 1.7% in non-smokers), the mortality hazard ratio (comparing matched non-surgical patients to surgical patients) did not differ significantly between smokers and non-smokers (p for interaction = .67). CONCLUSIONS: Bariatric surgery was associated with significantly lower mortality in both smokers and non-smokers.
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