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Thirty-day Mortality After Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery

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Abstract

Background

Mortality following bariatric surgery is a rare event in contemporary series, making it difficult for any single center to draw meaningful conclusions as to cause of death. Nevertheless, much of the published mortality data come from single-center case series and reviews of administrative databases. These sources tend to produce lower mortality estimates than those obtained from controlled clinical trials. Furthermore, information about the causes of death and how they were determined is not always available. The aim of the present report is to describe in detail all deaths occurring within 30 days of surgery in the Longitudinal Assessment of Bariatric Surgery (LABS).

Methods

LABS is a ten-center observational cohort study of bariatric surgical outcomes. Data were collected prospectively for bariatric surgeries performed between March 2005 and April 2009. All deaths occurring within 30-days of surgery were identified, and cause of death assigned by an independent Adjudication Subcommittee, blinded to operating surgeon and site.

Results

Six thousand one hundred eighteen patients underwent primary bariatric surgery. Eighteen deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%), and pulmonary embolism (17%). For one patient cause of death could not be determined despite examination of all available information.

Conclusions

This study confirms the low 30-day mortality rate following bariatric surgery. The recognized complications of anastomotic leak, cardiac events, and pulmonary emboli accounted for the majority of 30-day deaths.

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Acknowledgments

This clinical study was a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Grant numbers: DCC -U01 DK066557; Columbia—U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, Grant UL1-RR024996); University of Washington—U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute—U01-DK66471; East Carolina University—U01-DK66526; University of Pittsburgh Medical Center—U01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); Oregon Health and Science University—U01-DK66555.

LABS personnel contributing to the study include:

Columbia University Medical Center, New York, NY: Paul D. Berk, MD, Marc Bessler, MD, Amna Daud, Harrison Lobdell IV, Jemela Mwelu, Beth Schrope, MD, PhD, Akuezunkpa Ude, MD; Cornell University Medical Center, New York, NY: Michelle Capasso, BA, Ricardo Costa, BS, Greg Dakin, MD, Faith Ebel RD, MPH, Michel Gagner, MD, Jane Hsieh BS, Alfons Pomp, MD, Gladys Strain, PhD; Mt. Sinai Medical Center, New York, NY: W. Barry Inabnet, MD; East Carolina Medical Center, Greenville, NC: Rita Bowden, RN, William Chapman, MD, FACS, Lynis Dohm, PhD, John Pender MD, Walter Pories, MD, FACS; Neuropsychiatric Research Institute, Fargo, ND: Jennifer Barker, MBA, Michael Howell, MD, Luis Garcia, MD, FACS, MBA, Kathy Lancaster, BA, Erika Lovaas, BS, James E. Mitchell, MD, Tim Monson, MD; Oregon Health and Science University: Chelsea Cassady, BS, Clifford Deveney, MD, Katherine Elder, PhD, Andrew Fredette, BA, Stefanie Greene, Jonathan Purnell, MD, Robert O’Rourke, Lynette Rogers, MD, Chad Sorenson, Bruce M. Wolfe, MD; Legacy Good Samaritan Hospital, Portland, OR: Emma Patterson, MD, Mark Smith, MD, William Raum, MD, Lisa VanDerWerff, PAC, Jason Kwiatkowski, PAC, Jamie Laut Med; Sacramento Bariatric Medical Associates, Sacramento, CA: Iselin Austrheim-Smith, CCRP, Laura Machado, MD; University of Pittsburgh Medical Center, Pittsburgh, PA: Chris Costa, BA Anita P. Courcoulas, MD, MPH, FACS, Jessie Eagleton, BS, George Eid, MD, William Gourash, MSN, CRNP, Lewis H. Kuller, MD, DrPH, Carol A. McCloskey, MD, Ramesh Ramanathan, MD, Rebecca Search, MPH, Eleanor Shirley, MA; University of Washington, Seattle, WA: David E. Cummings, MD, E. Patchen Dellinger, MD, Hallie Ericson, BA, David R. Flum, MD, MPH, Katrina Golub, MPH, CCRC, Brant Oelschlager, MD, Skye Steptoe, MS, CCRC, Tomio Tran, Andrew Wright, MD; Virginia Mason Medical Center, Seattle, WA: Lily Chang, MD, Stephen Geary, RN, Jeffrey Hunter, MD, Anne MacDougall, BA Ravi Moonka, MD, Olivia A. Seibenick, CCRC, Richard Thirlby, MD; Data Coordinating Center, Graduate School of Public Health at the University of Pittsburgh, Pittsburgh, PA: Abi Adenijii, MS, Steven H. Belle, PhD, MScHyg, Lily (Jia-Yuh) Chen, MS, Michelle Fouse, BS, Jesse Hsu, MS, Wendy C. King, PhD, Kevin Kip, PhD, Kira Leishear, BS, Laurie Iacono, MFA, Debbie Martin, BA, Rocco Mercurio, MBA, Faith Selzer, PhD, Abdus Wahed, PhD; National Institute of Diabetes and Digestive and Kidney Diseases: Mary Evans, PhD, Mary Horlick, MD, Carolyn W. Miles, PhD, Myrlene A. Staten, MD, Susan Z. Yanovski, MD; National Cancer Institute: David E. Kleiner, MD, PhD.

Conflicts of Interest

Mark D. Smith, Abdus S. Wahed, Steven H. Belle, Paul D. Berk, Anita P. Courcoulas, Gregory F. Dakin, Laura Machado, James E. Mitchell, John Pender, Alfons Pomp, Ramesh Ramanathan, Beth Schrope, Myrlene Staten, and Akuezunkpa Ude have no relevant financial interests to disclose. Emma Patterson discloses that she is an owner and co-founder of Doctors of Weight Loss, and receives consulting fees from Transenterix, Allergan Health, and Reshape Medical. David R. Flum discloses that he receives research grant support from Covidien and Sanofi Aventis. Walter Pories discloses that he receives research grant support from Ethicon and GlaxoSmithKline. Bruce M. Wolfe discloses that he receives consulting fees from EnteroMedics and Crospon/Wellcome.

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Authors and Affiliations

  1. Legacy Good Samaritan Hospital, 1040 NW 22nd Ave, Suite 500, Portland, OR, 97210, USA

    Mark D. Smith & Emma Patterson

  2. Data Coordinating Center, Graduate School of Public Health at the University of Pittsburgh, Pittsburgh, PA, USA

    Abdus S. Wahed & Steven H. Belle

  3. Columbia University Medical Center, New York, NY, USA

    Paul D. Berk, Beth Schrope & Akuezunkpa Ude

  4. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Anita P. Courcoulas & Ramesh Ramanathan

  5. Weill Cornell Medical College, New York, NY, USA

    Gregory F. Dakin & Alfons Pomp

  6. University of Washington, Seattle, WA, USA

    David R. Flum

  7. Sacramento Bariatric Medical Associates, Sacramento, CA, USA

    Laura Machado

  8. Neuropsychiatric Research Institute, Fargo, ND, USA

    James E. Mitchell

  9. East Carolina Medical Center, Greenville, NC, USA

    John Pender & Walter Pories

  10. National Institute of Diabetes and Digestive and Kidney Diseases, Iowa City, IA, USA

    Myrlene Staten

  11. Oregon Health and Science University, Portland, OR, USA

    Bruce M. Wolfe

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  1. Mark D. Smith
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  2. Emma Patterson
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  15. Beth Schrope
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  18. Bruce M. Wolfe
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Corresponding author

Correspondence to Mark D. Smith.

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Smith, M.D., Patterson, E., Wahed, A.S. et al. Thirty-day Mortality After Bariatric Surgery: Independently Adjudicated Causes of Death in the Longitudinal Assessment of Bariatric Surgery. OBES SURG 21, 1687–1692 (2011). https://doi.org/10.1007/s11695-011-0497-8

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  • DOI: https://doi.org/10.1007/s11695-011-0497-8

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