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Daniel P. Schauer, MD, MSc; David E. Arterburn, MD, MPH; Edward H. Livingston, MD; David Fischer, MD; Mark H. Eckman, MD, MS

Arch Surg. 2010;145(1):57-62.

Objective  To create a decision analytic model to estimate the balance between treatment risks and benefits for patients with morbid obesity.

Design  Decision analytic Markov state transition model with multiple logistic regression models as inputs. Data from the 2005 National Inpatient Survey were used to calculate in-hospital mortality risk associated with bariatric surgery and then adjusted for 30-day mortality. To calculate excess mortality associated with obesity, we used the 1991-1996 National Health Interview Survey linked to the National Death Index. Bariatric surgery was assumed to influence mortality only through its impact on the excess mortality associated with obesity, and the efficacy of surgery was estimated from a recent large observational trial.

Intervention  Gastric bypass surgery.

Main Outcome Measure  Life expectancy.

Results  Our base case, a 42-year-old woman with a body mass index of 45, gained an additional 2.95 years of life expectancy with bariatric surgery. No surgical treatment was favored in our base case when the 30-day surgical mortality exceeded 9.5% (baseline 30-day mortality, 0.2%) or when the efficacy of bariatric surgery for reducing mortality decreased to 2% or less (baseline efficacy, 53%).

Conclusions  The optimal decision for individual patients varies based on the balance of risk between perioperative mortality, excess annual mortality risk associated with increasing body mass index, and the efficacy of surgery; however, for the average morbidly obese patient, gastric bypass improves life expectancy.

Author Affiliations: Divisions of General Internal Medicine (Drs Schauer and Eckman) and General Surgery (Dr Fischer), University of Cincinnati Medical Center, Cincinnati, Ohio; Group Health Center for Health Studies, Seattle, Washington (Dr Arterburn); and Department of Gastrointestinal and Endocrine Surgery, Southwestern School of Medicine, University of Texas, Dallas (Dr Livingston).

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