Men undergoing surgery for obesity are five times as likely to die within 30 days of the procedure compared to women, and the mortality in the long term is almost three times higher, said an analysis of national data from Austria.
The researchers presented the findings at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online (September 27- October 1).
The study said that men tend to be older and have higher rates of comorbidities like cardiovascular disease and type 2 diabetes at the time of surgery. This highlighted the need to educate men about the importance of treating obesity earlier, before they develop potentially life-threatening comorbidities, the researchers noted.
Lead author Dr Hannes Beiglböck (Medical University of Vienna, Austria) pointed out that though surgical procedures are one of the most successful ways to help people with extreme obesity to lose weight, they can come with complications. He said that though the absolute risk of dying after bariatric surgery is low, the findings highlighted a substantially increased mortality risk among men compared to women. Women seem more willing to look at surgical weight loss earlier in life, whereas men tend to wait until they have more comorbidities,” said Beiglböck.
With an increase in obesity rate across the world, the number of people seeking weight-loss surgery has also increased. The surgery involves procedures that either limit the amount of food that can be consumed or reduce food absorption. These can lead to weight loss and lower risks of chronic conditions associated with severe obesity including cardiovascular disease, high blood pressure, type 2 diabetes and cancer.
The researchers analysed medical health claim data from the Austrian state insurance (the Osterreichische Gesundheitskasse) that covers around 98 per cent of the population. In total, 19.901 patients (14,681 women average age 41 years; 5,220 men, average age 42 years) who had undergone bariatric surgery (sleeve gastrectomy, gastric banding, biliopancreatic diversion, gastric bypass) between January 2010 and December 2018 were included in the analyses and followed for an average of 5 years (107,806 patient years of observation). Researchers analysed sex specific differences in comorbidities associated with obesity (type 2 diabetes, cardiovascular diseases, psychiatric disorders, and cancers) in patients who died.
They found that less than two per cent (367/19,901; 176 men and 191 women) died of bariatric surgery between January 2010 and April 2020. Nevertheless, overall postoperative mortality rates (per year of observation) were almost three times higher among men than women (0.64% vs 0.24%-although deaths were rare in absolute terms; whilst 30-day mortality was five-fold higher in men compared to women (25 deaths, 0.5% vs 12 deaths, 0.1%). The researchers noted that men with cardiovascular diseases (84% of men, 80% of women) and psychiatric disorders (51% of men, 58% of women) were the most common comorbidities. Type 2 diabetes was more common in men than women who died (43% vs 33%), and cancers were more common in women than men (41% vs 30%). Beiglböck points out that the challenge now is to understand potential barriers for men to undergo bariatric surgery and further research should be performed to explore if earlier surgical intervention in men could improve mortality outcomes.