Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched,
observational cohort study
 
Vasileios Liakopoulos,1,2 Stefan Franzén,3,4 Ann-Marie Svensson,1,3 Mervete Miftaraj,3 Johan Ottosson,5 Ingmar Näslund,5 Soffia Gudbjörnsdottir,1,3 Björn Eliasson1,2
 
Abstract
Objectives
Long-term effects of gastric bypass (GBP)
surgery have been presented in observational and
randomised studies, but there are only limited data for
persons with obesity and type 2 diabetes mellitus (T2DM)
regarding postoperative complications.
 
Design
This is a nationwide observational study based
on two quality registers in Sweden (National Diabetes
Register, NDR and Scandinavian Obesity Surgery Register,
SOReg) and other national databases.
Setting After merging the data, we matched individuals
with T2DM who had undergone GBP with those not
surgically treated for obesity on propensity score, based
on sex, age, body mass index (BMI) and calendar time. The
risks of postoperative outcomes (rehospitalisations) were
assessed using Cox regression models.
Participants We identified 5321 patients with T2DM in
the SOReg and 5321 matched controls in the NDR, aged
18–65 years, with BMI >27.5 kg/mÇ and followed for up to
9 years.
 
Primary and secondary outcome measures
We assessed risks for all-cause mortality and hospitalisations
for cardiovascular disease, severe kidney disease, along
with surgical and other medical conditions.
 
Results
The results agree with the previously suggested
lower risks of all-cause mortality (49%) andcardiovascular
disease (34%), and we also found positive effects for
severe kidney disease but significantly increased risks
(twofold to ninefold) of several short-term complications
after GBP, such as abdominal pain and gastrointestinal
conditions, frequently requiring surgical procedures,
apart from reconstructive plastic surgery. Long-term, the
risk of anaemia was 92% higher, malnutrition developed
approximately three times as often, psychiatric diagnoses
were 33% more frequent and alcohol abuse was three
times as great as in the control group.
 
Conclusions This nationwide study confirms the benefits
and describes the panorama of adverse events after
bariatric surgery in persons with obesity and T2DM.
 
Long-term postoperative monitoring and support, as
better selection of patients by appropriate specialists in
interdisciplinary settings, should be provided to optimise
the outcomes.
 
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