Factors associated with anemia after bariatric surgery

Bariatric surgery increases the risk of anemia, but long-term data from large cohorts are sparse, and it is unclear if certain groups are at a higher risk.

Define factors associated with anemia at 5 years of follow-up after bariatric surgery.

Data from a national quality register.

This cross-sectional study uses Scandinavian Obesity Surgery Registry data on primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures in Sweden from 2007 to 2020. Hemoglobin and ferritin were analyzed preoperatively and up to 10 years postoperatively. Factors associated with anemia were evaluated using hemoglobin and ferritin samples 5 years postsurgery.

The study included 73,612 patients (RYGB: 80.7%, SG: 19.3%). Hemoglobin and/or ferritin data were available for 18,993 patients 5 years postsurgery, of whom 3508 patients (18.5%) had anemia and 691 patients (27.0%) subnormal ferritin levels. Anemia and subnormal ferritin were more prevalent after RYGB than SG (19.6% versus 11.3%, adjusted odds ratio [aOR] = .58 and 24.1% versus 15.6%, aOR = .43). Females had a higher prevalence of anemia than males (20.6% versus 11.1%, aOR = .50). Young age was associated with a higher risk of anemia (31.0%), as was large postoperative weight loss (highest quartile 25.2%). Results regarding iron supplementation were not conclusive.

The prevalence of anemia, likely secondary to iron deficiency, increases up to 10 years post bariatric surgery. Female sex, young age at surgery, large weight loss, and undergoing RYGB were associated with an increased risk of anemia, indicating a need for targeted strategies for vitamin and mineral supplementation in these groups.