Incidence of Cancer and Cardiovascular Disease After Bariatric Surgery in Older Patients
Authors' conclusion
This cohort study found that bariatric surgery in older patients is not associated with lower rates of obesity-related cancer and cardiovascular events, but there was evidence that gastric bypass may be associated with lower risk of both outcomes.
Study context
- Population
- Patients aged ≥60 years treated for obesity without previous malignant neoplasm or CVD, Denmark, Finland and Sweden, 1989–2019; median age 63 years, 66.4% femalematched cohort
- Participants
- 15,300 patients
- Exposure
- Bariatric surgery at age ≥60 years vs nonoperative treatment for obesity
- Bariatric surgeryn = 2,550
- Nonoperative treatmentn = 12,750reference
- Outcome
- Obesity-related cancer: composite of breast, endometrial, esophageal, colorectal and kidney cancer
- Follow-up
- median 5.8 (IQR 2.8-8.5) person-years of follow-up
Methodological detailsmultinational (Denmark, Finland, Sweden), exactly matched on country, sex and age at surgery date, nonoperative obesity treatment controls, multivariable Cox regression, Data analyzed in December 2023
- Multinational (Denmark, Finland, Sweden)
- Exactly matched on country, sex and age at surgery date
- Nonoperative obesity treatment controls
- Multivariable Cox regression
- Data analyzed in December 2023
Main finding
As reported in the abstract
Obesity-related cancer:
- Breast
- Endometrial
- Esophageal
- Colorectal
- Kidney cancer
Developed obesity-related cancer, whole cohort
658
4.3%
Risk of obesity-related cancer similar among those who underwent surgery and those who did not: HR
0.81
95% CI 0.64–1.03
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Gastric bypass | Matched controls | HR (95% CI) | |
|---|---|---|---|---|
| Obesity-related cancer, gastric bypass subgroup | 3.7% | 4.6% | 0.74 (0.56–0.97) | |
| CVD, gastric bypass subgroup | 8.2% | 8.9% | 0.82 (0.69–0.99) | |
| 0.512Hazard ratio (log scale) |
- Obesity-related cancer, gastric bypass subgroup: Gastric bypass n = 1930; matched controls n = 9650
CVD (composite of MI, ischemic stroke and cerebral hemorrhage) · median (IQR) follow-up 5.8 (2.8-8.5) person-years
- Developed CVD, whole cohort
- 1436 (9.4%)
- Risk of CVD similar among those who underwent surgery and those who did not: HR
- 0.86 (95% CI, 0.74-1.01)
- HR adjusted for diabetes, hypertension, peripheral vascular disease, COPD, kidney disease and frailty
Original publication
Incidence of Cancer and Cardiovascular Disease After Bariatric Surgery in Older Patients. JAMA Netw Open. Published 1 August 2024. doi:10.
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