Bariatric surgery: A systematic review and meta-analysis

Henry Buchwald, Yoav Avidor, Eugene Braunwald, Michael Dennis Jensen, Walter Pories, Kyle Fahrbach, Karen Schoelles

Research output: Contribution to journalArticle

4622 Citations (Scopus)

Abstract

Context: About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. Objective: To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). Data Sources and Study Selection: Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. Data Extraction: A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). Data Synthesis: A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. Conclusions: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

Original languageEnglish (US)
Pages (from-to)1724-1737
Number of pages14
JournalJournal of the American Medical Association
Volume292
Issue number14
DOIs
StatePublished - Oct 13 2004

Fingerprint

Bariatric Surgery
Meta-Analysis
Obstructive Sleep Apnea
Hyperlipidemias
Biliopancreatic Diversion
Weight Loss
Gastric Bypass
Hypertension
Gastroplasty
Diet Therapy
Mortality
Information Storage and Retrieval
MEDLINE
Population
Libraries
Comorbidity
Stomach

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. Journal of the American Medical Association, 292(14), 1724-1737. https://doi.org/10.1001/jama.292.14.1724

Bariatric surgery : A systematic review and meta-analysis. / Buchwald, Henry; Avidor, Yoav; Braunwald, Eugene; Jensen, Michael Dennis; Pories, Walter; Fahrbach, Kyle; Schoelles, Karen.

In: Journal of the American Medical Association, Vol. 292, No. 14, 13.10.2004, p. 1724-1737.

Research output: Contribution to journalArticle

Buchwald, H, Avidor, Y, Braunwald, E, Jensen, MD, Pories, W, Fahrbach, K & Schoelles, K 2004, 'Bariatric surgery: A systematic review and meta-analysis', Journal of the American Medical Association, vol. 292, no. 14, pp. 1724-1737. https://doi.org/10.1001/jama.292.14.1724
Buchwald, Henry ; Avidor, Yoav ; Braunwald, Eugene ; Jensen, Michael Dennis ; Pories, Walter ; Fahrbach, Kyle ; Schoelles, Karen. / Bariatric surgery : A systematic review and meta-analysis. In: Journal of the American Medical Association. 2004 ; Vol. 292, No. 14. pp. 1724-1737.
@article{637d01680f1b4fa9bbdc9826f22b7be4,
title = "Bariatric surgery: A systematic review and meta-analysis",
abstract = "Context: About 5{\%} of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. Objective: To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). Data Sources and Study Selection: Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. Data Extraction: A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6{\%} were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8{\%}). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). Data Synthesis: A random effects model was used in the meta-analysis. The mean (95{\%} confidence interval) percentage of excess weight loss was 61.2{\%} (58.1{\%}-64.4{\%}) for all patients; 47.5{\%} (40.7{\%}-54.2{\%}) for patients who underwent gastric banding; 61.6{\%} (56.7{\%}-66.5{\%}), gastric bypass; 68.2{\%} (61.5{\%}-74.8{\%}), gastroplasty; and 70.1{\%} (66.3{\%}-73.9{\%}), biliopancreatic diversion or duodenal switch. Operative mortality (≤30 days) in the extracted studies was 0.1{\%} for the purely restrictive procedures, 0.5{\%} for gastric bypass, and 1.1{\%} for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8{\%} of patients and resolved or improved in 86.0{\%}. Hyperlipidemia improved in 70{\%} or more of patients. Hypertension was resolved in 61.7{\%} of patients and resolved or improved in 78.5{\%}. Obstructive sleep apnea was resolved in 85.7{\%} of patients and was resolved or improved in 83.6{\%} of patients. Conclusions: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.",
author = "Henry Buchwald and Yoav Avidor and Eugene Braunwald and Jensen, {Michael Dennis} and Walter Pories and Kyle Fahrbach and Karen Schoelles",
year = "2004",
month = "10",
day = "13",
doi = "10.1001/jama.292.14.1724",
language = "English (US)",
volume = "292",
pages = "1724--1737",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "14",

}

TY - JOUR

T1 - Bariatric surgery

T2 - A systematic review and meta-analysis

AU - Buchwald, Henry

AU - Avidor, Yoav

AU - Braunwald, Eugene

AU - Jensen, Michael Dennis

AU - Pories, Walter

AU - Fahrbach, Kyle

AU - Schoelles, Karen

PY - 2004/10/13

Y1 - 2004/10/13

N2 - Context: About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. Objective: To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). Data Sources and Study Selection: Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. Data Extraction: A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). Data Synthesis: A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. Conclusions: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

AB - Context: About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. Objective: To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). Data Sources and Study Selection: Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. Data Extraction: A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22 094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). Data Synthesis: A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (≤30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. Conclusions: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

UR - http://www.scopus.com/inward/record.url?scp=5044242948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=5044242948&partnerID=8YFLogxK

U2 - 10.1001/jama.292.14.1724

DO - 10.1001/jama.292.14.1724

M3 - Article

C2 - 15479938

AN - SCOPUS:5044242948

VL - 292

SP - 1724

EP - 1737

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 14

ER -