Benchmarking weight loss and survival benefits after gastric bypass: a long-term cohort study

With the rise of glucagon-like peptide-1 receptor agonists for obesity, rigorous long-term data on surgical outcomes are essential to establish benchmarks and inform future comparative effectiveness studies.

To evaluate long-term weight loss, safety, and survival following Roux-en-Y gastric bypass (RYGB).

Community Teaching Hospital.

This retrospective cohort included all primary RYGB procedures between 2006 and 2011. Outcomes assessed included complications, mortality, and weight loss before glucagon-like peptide 1 (GLP-1) initiation. Mortality was compared with a propensity-weighted national reference cohort to establish population-level benchmarks.

One thousand three-hundred fourteen consecutive RYGB patients were identified with an average follow-up of 11.7 years; 82% had available data at 10 years. In weighted, adjusted models, RYGB was associated with a 67% mortality reduction in patients aged 55-64 (.33; P = .045) and 53% reduction for patients ≥65 (.47; P = .005), but no reduction in patients <55. Total body weight loss at 2 years was 35% ± .3%, and at 10 years, 28.5% ± .4%. Higher initial weight, younger age, and Caucasian race were associated with greater weight loss. At 10 years, 1.8% of patients weighed more than before surgery. At least 5% of RYGB patients developed "severe" alcohol use disorder, with younger patients at higher risk. Of the 137 deaths, we identified a cause in 99. Seven deaths were directly attributable to RYGB complications, and 22 (16%) to liver failure.

RYGB provides durable, meaningful long-term weight loss and a marked survival benefit in patients older than 55. These findings establish a benchmark for emerging medical therapies.