Mortality After Bariatric Surgery: A Comprehensive Review

Understanding mortality risk following bariatric surgery is crucial for clinical decision-making as these procedures increase globally.

To analyze current evidence regarding perioperative, intermediate, and long-term mortality following bariatric surgery across different techniques and patient populations.

Systematic literature search in PubMed, Embase, and Cochrane databases (2015-2025) for studies reporting mortality after bariatric surgery. Large-scale registries, meta-analyses, and long-term follow-up studies were prioritized.

Among 42 studies meeting inclusion criteria (> 1.2 million procedures), perioperative mortality (≤ 30 days) was 0.08% (95% CI, 0.06-0.11%) for primary procedures. Procedure-specific mortality: sleeve gastrectomy (0.03-0.08%), adjustable gastric banding (0.01-0.05%), Roux-en-Y gastric bypass (0.07-0.2%), and biliopancreatic diversion (0.2-0.5%). Revisional surgery carried higher risk (0.3-0.5%). Long-term all-cause mortality was 30-50% lower among bariatric surgery patients versus non-surgical controls (HR 0.45-0.75). Cardiovascular mortality reduction was most pronounced (HR 0.47, 95% CI 0.36-0.62). Risk factors for increased mortality included age > 65 years, male sex, BMI > 50 kg/m², significant comorbidities, and low-volume centers.

Modern bariatric surgery demonstrates remarkably low perioperative mortality, particularly for primary procedures in experienced centers. Long-term survival benefits substantially outweigh early risks in appropriately selected patients. Further research should focus on risk mitigation in highest-risk populations and global standardization of safety protocols.