Refining Bariatric Surgery: A Nationwide 15-year Study to Reduce Morbidity and Improve Recovery

To evaluate the evolution of postoperative mortality and morbidity associated with bariatric surgery over a 15-year period using a nationwide database.

Bariatric surgery is a cornerstone in obesity management, demonstrating significant benefits in weight loss and comorbidity resolution. However, despite its proven efficacy, it remains underutilized, with only a small fraction of eligible patients undergoing surgery. Advances in surgical techniques and perioperative care have improved safety, yet long-term trends in mortality and morbidity require further evaluation.

This retrospective cohort study utilized data from the SNDS (Système National des Données de Santé), France's national health care database, covering all bariatric procedures performed between 2009 and 2023. Patients aged 18 to 65 years with a primary diagnosis of obesity were included. Outcomes assessed included 90-day and 180-day mortality, severe complications (Clavien-Dindo IV), reoperations, hospital readmissions, and postoperative medication use.

Among 486,161 first-time bariatric procedures, sleeve gastrectomy and gastric bypass dominated. The overall 90-day mortality rate was 0.1%, varying significantly by procedure ( P < 0.001), with adjustable gastric banding exhibiting the lowest rate. Mortality decreased by 40% over time, but sleeve gastrectomy and gastric bypass showed a plateau effect since 2018. Reoperations declined (4.9%-4.5%), and intensive care unit admissions for severe complications fell by 58%. Medication analysis revealed reduced analgesic (-29.4%), antidepressant (-15.7%), and anxiolytic (-12.7%) use, while laxative consumption increased (+86.4%).

Bariatric surgery has become safer over time, with declining mortality and complication rates. However, the stagnation of improvements in recent years highlights the need for further optimization strategies. These findings support the continued integration of surgery within a multimodal obesity treatment paradigm.