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Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis

Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore
National Addictions Management Service, Institute of Mental Health, Singapore 539747, Singapore
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(7), 1519;
Submission received: 23 June 2018 / Revised: 13 July 2018 / Accepted: 13 July 2018 / Published: 18 July 2018
(This article belongs to the Special Issue Adult Psychiatry)


Introduction: Prior meta-analysis has reported mortality rates among post-operative bariatric patients, but they have not considered psychiatric factors like suicide contributing to mortality. Objectives: The current meta-analysis aims to determine the pooled prevalence for mortality and suicide amongst cohorts using reported suicides post bariatric surgery. It is also the aim of the current meta-analytical study to determine moderators that could account for the heterogeneity found. Results: In our study, the pooled prevalence of mortality in the studies which reported suicidal mortality was 1.8% and the prevalence of suicide was 0.3%. Mean body mass index (BMI) and the duration of follow-up appear to be significant moderators. Conclusions: Given the prevalence of suicide post bariatric surgery, it is highly important for bariatric teams to consider both the medical and psychiatric well-being of individuals pre- and post-operatively.

1. Introduction

In 2014, the World Health Organization reported that there are an estimated 1.9 billion adults who were overweight, with approximately 600 million deemed to be obese (with a body mass index of more than 30) [1]. These figures highlight that obesity is clearly a problem that afflicts a global population. The increasing rates of obesity globally can be attributed mainly to changing dietary norms, as well as decreasing levels of physical activity among individuals [1]. Obesity heightens the risk of an individual developing medical comorbidities, such as diabetes, cardiovascular diseases and some forms of carcinomas [2]. Apart from the association between obesity and medical disorders, prior research has highlighted an association between obesity and psychiatric disorders [3]. In the aforementioned review [3], there was evidence of a bi-directional association of obesity and depressive disorders and females, in particular, tend to be at risk. An association between obesity and anxiety disorders was also found, and alcohol abuse appears to be a predisposing factor towards the development of obesity [3].
Various strategies have been implemented in order to tackle the growing problem of obesity. Such strategies include educational and dietary programs [4]. While these programs are largely efficacious, there are individuals who remains severely obese, despite their participation in these programs. Various clinical guidelines recommend bariatric surgery as an option for individuals who have recalcitrant obesity, that is, refractory to non-operative management [5,6]. Bariatric surgery has been widely utilized, with approximately 468,809 procedures done in 2013 [7], and has been effective in the management of obesity. There is a variety of operative procedures that can be performed, and the amount of weight loss is dependent on the procedure utilized. Aside from the main benefits of weight loss, individuals who have undergone bariatric surgery may also gain optimal control of their diabetic and hypertensive disorders and resolution of obstructive sleep apnoea [8,9,10].
While bariatric surgery seems to be a solution to obesity as well as the associated medical comorbidities, prior studies have highlighted that there remains an elevated risk of suicide among patients who have undergone bariatric surgery [11]. A prior meta-analysis reported that the suicide rate was 4.1/10,000 person-years among post-operative bariatric patients, and this was four times higher as compared to the general population [12]. Other studies (Tindle et al.) [13] have reported rates of suicide as high as 6.6/10,000 patients. Obesity is associated with a variety of psychiatric and affective disorders, for example, depressive disorders are commonly associated with obesity. A recent study of 10,000 bariatric patients in Canada reported that 41.7% of patients had depression and 2.2% had bipolar disorder pre-operatively [14]. There have been studies reporting that the risk of post-operative suicide remains high [15]. A prior study reported that self-esteem might account for the relationship between obesity and suicidality [16]. Self-esteem affect one’s viewpoint of one’s body image and individuals with low self-esteem might have a poorer perception of their body image, which leads to the development of depression [16]. In addition, some of the chronic medical comorbidities may persist despite bariatric surgery and the presence of these medical issues might cause an individual to have a sense of failure and disappointment [17]. It is also important to recognize that the risk of suicide is increased among individuals with disorders such as diabetes. Bariatric surgery can also result in physiological changes, and this may affect the metabolism of substances like alcohol, which might be implicated in suicide attempts. Changes in the levels of peripheral released peptides might also affect mood. Patients with pre-existing emotional eating disorders might still have maladaptive patterns of eating post-operatively that lead to weight gain and result in a sense of disappointment.
Previous studies have reported short-term as well as long-term all-cause mortality (Cardoso et al., 2017) [11]. The estimated prevalence of short-term mortality was 0.18% and it was also reported that operated patients were less likely to succumb to cardiovascular disorders and carcinomas in the longer-term. Whilst the meta-analysis performed by Cardoso et al. (2017) [11] appears to be comprehensive and timely, one of the major limitations is that the authors have not considered mortality due to suicide in their review. Also, the prior study [12] examining the prevalence of completed suicide was done more than 4 years ago. Hence, a current meta-analysis is of importance in providing an updated pooled prevalence rate for suicide, and for comparing it against that of all-cause mortality in the same cohort.
Thus, this meta-analysis aims to determine the pooled prevalence of mortality and suicide among the cohort of bariatric surgery patients with reported suicides. It is also the aim of the meta-analysis to determine the moderators that account for the heterogeneity of the pooled prevalence obtained.

2. Methodology

2.1. Comprehensive Search Strategy

A comprehensive search was undertaken between 1 January 2017 and 28 February 2017. Entire databases were searched from inception with the following databases being evaluated: PubMed (since 1966), Embase (since 1980), PsychINFO (since 1806), BIOSIS (since 1926), Science Direct (since 2006), and Cochrane CENTRAL (since 1993).
The keywords used in the search strategy include; (obesity surgery, bariatric surgery, gastric bypass, biliopancreatic diversion, endoluminal sleeve, vertical banded gastroplasty, gastric band, sleeve gastrectomy, gastric balloon, gastric plication, duodenal switch, implantable gastric stimulation) AND (suicide OR mortality).

2.2. Inclusion and Exclusion Criteria

The inclusion criteria for the meta-analysis were as follows: (1) papers which provided numbers of suicide in the cohort, and (2) papers with recipients of bariatric surgery form the study population.
The exclusion criteria for the meta-analysis were as follows: (1) non-English language papers, and (2) papers with unclear/unknown causes of death listed.

2.3. Selection of Articles

All the titles, authors’ information, as well as the journal and year of publication were removed prior to the selection procedure. Selection of the relevant publications were conducted independently by of the first two authors (RBCL & MWBZ) of this paper. In the first phase, articles were screened based on their titles as well as abstract. Those articles which were shortlisted were then evaluated against the aforementioned inclusion and exclusion criteria. In the event of any disagreement amongst the two authors, it was resolved by means of a discussion with the author, RCMH. The selection procedure was in accordance to PRISMA guidelines.

2.4. Statistical Methods

2.4.1. Data Extraction

The following information was extracted from each of the article, cross-checked by the second author as well as the last author and recorded on a standardized electronic data collation form: (a) publication details (names of the authors and year of publication); (b) the total number of deaths as well as the number of suicides; (c) the total sample size of each of the studies; (d) the mean age of the participants; (e) the proportion of males and females in the population surveyed; (f) the mean BMI of the participants; (g) the operative procedure utilized; (h) the country in which the participant were sampled from, and lastly, (i) the total duration of the follow-up.

2.4.2. Statistical Analysis

All statistical analyses were performed using comprehensive meta-analysis. This meta-analysis used a random-effects model that assumed heterogeneity between studies and their respective effect sizes (Ho et al. 2010, Cheung et al. 2012) [18,19]. We used standardized mean difference to establish the overall effect size in each of the studies and presented our findings in the forest plots. We reported the results using 95% confidence interval (CI). Between-study heterogeneity was assessed with the I2 statistic (Loh et al. 2017) [20]. As a guide, I2 values of 25% were considered low, 50% moderate, and 75% high (Ho et al. 2016) [21]. For models with considerable heterogeneity, a meta-regression was performed to identify the moderators which might contribute to the heterogeneity of the effect sizes (Lu et al. 2012) [22]. The regression coefficients and the associated z values and p values were reported in the meta-regression analysis. In the event that publication bias was detected, the classic fail-safe test was performed to establish the potential number of missing studies (Puthran et al. 2016) [23]. Egger’s regression test was also conducted to determine if publication bias was present.
Two separate subgroup analyses were undertaken to investigate the effects of categorical variables on the pooled prevalence of mortality amongst cohort with reported suicide and on the pooled prevalence of suicide itself. We compared the prevalence of suicide among the following subgroups: (a) operative procedure that was utilized and (b) continent in which the study was conducted.

3. Results

A cumulative total of 7614 published abstract were screened and 390 full text articles were reviewed and were selected based on our inclusion criteria. Sixty-one studies with a pooled cohort size of 142,356 were included in this systematic review and meta-analysis (Figure 1). Characteristics of the studies included are described in Table 1. There was a total of 43 prospective cohort studies, 14 retrospective cohort studies, one randomized controlled study and three case control studies. The studies which we identified have reported all-cause mortality and mortality due to suicide.
Overall, the pooled prevalence of mortality in these studies which reported suicidal mortality was 1.8% (95% confidence interval 1.4–2.4%, Z = −29.228, df = 60, τ2 = 0.933, I2 = 95.779). This meta-analysis revealed significant heterogeneity across studies (p < 0.001). The pooled prevalence of suicide was 0.3% (95% confidence interval 0.3–0.4%, Z = −39.133, df = 60, τ2 = 0.684, I2 = 66.202).
We also tested for publication bias using the Egger regression test. Publication bias was not evident in the meta-analysis of all the studies (intercept = −0.98486, 95% CI: −2.79555–0.82584, t = 1.08836, df = 59, p = 0.28086).
In the meta-regression analyses (Table 2), certain variables were found to be significantly associated with the overall pooled mortality prevalence. We found that the mean BMI (β = 0.008282, Z = 2.37980, p = 0.01732) and the follow-up interval (β = 0.01177, Z = 4.34545, p = 0.00001) were significant moderators for the pooled mortality prevalence. The mean age of the sampled cohort as well as the proportion of males in the sampled cohort were not found to be moderators.
Subgroup analysis of the prevalence rates based on the random effects model for the categorical variables (the types of bariatric surgical procedure as well as the continent where the cohort was sampled) found that these variables were not moderators for the overall prevalence of mortality among bariatric cohorts with reported suicide mortality (Table 3).
A further subgroup analysis was performed for the prevalence rates of suicide based on the random effects model for categorical variables (the types of bariatric surgical procedure as well as the continent where the cohort was sampled) and found that these variables were not moderators for the overall prevalence of mortality among bariatric patients (Table 4).

4. Discussion

The current meta-analysis is, to our knowledge, the most up-to-date meta-analysis to examine the pooled prevalence of all-cause mortality as well as suicide in bariatric surgery cohorts with reported suicides. In our current study, the pooled prevalence of all-cause mortality was 1.8% across a total of 61 studies with a pooled cohort size of 142,356. The pooled prevalence of suicide was 0.3%. Notably, our computed pooled prevalence rates were much higher than those reported by prior studies, such as that of Cardoso et al. (2017) [11], in which it was reported that the short-term all-cause mortality rate was 0.18%; and that of Chang et al. [84], that reported a mortality rate of 0.08%. Based on our computation, the rate of all-cause mortality is approximately 6 times higher than that for suicide. This implies that some bariatric patients do experience other complications that might result in morbidity and eventual mortality. Rottensterich et al. (2016) [85] has reported that whilst bariatric surgery helps in the weight loss amongst individuals with Type 1 diabetes, some individuals experience post-operative complications such as diabetic ketoacidosis and hypoglycaemic episodes. Prior studies have reported that factors such as gender, age, high baseline body mass index, the presence of pre-existing diabetes, history of percutaneous coronary intervention, a history of peripheral vascular disease and a need for reoperation heighten the chances of post-operative mortality [86].
The pooled prevalence of suicide after bariatric surgery was 0.3%. This is a notable finding, given that most of the recent meta-analysis and systematic reviews have not reported on mortality due to psychiatric conditions. The most recent review that has considered suicide following bariatric surgery was conducted by Peterhansel et al. (2012) [12], who reported that the suicide rate was estimated to be that of 4.1/10,000 person-years. To put these rates into perspective, the prevalence of suicide globally is 1.4%, based on an epidemiological study by the World Health Organization [87]. Despite the fact that the pooled prevalence of suicide is 6 times lower than that of all-cause mortality, and that the rates are also comparatively lower as compared to the rates among the general population (1.4%), there is still a need for a comprehensive evaluation of the psychiatric well-being of individuals both pre and post-operatively. Prior studies have highlighted the association between bariatric surgery and suicide (Adam et al., 2015) [88]. Roziblatt et al. (2016) [89] suggested that individuals who have pre-existing psychiatric conditions such as depression and eating disorders, are more likely to be at risk for suicide post-surgery. Thus, given this heightened risk, Roziblatt et al. (2016) [89] recommended the need for a psychiatrist to follow up with the patient prior to and after their slated surgery. Yen et al. (2016) [15] reported that 40% of bariatric patients have underlying psychiatric disorders and stressed that it is of importance for early identification and optimization of these conditions, as they in turn affect the outcome of the surgery. Yen et al. (2016) [15] also recommended various non-pharmacological options such as psychotherapy to help individuals with their depressive symptoms post-surgery. Based on the characteristics of the study presented in Table 1, there has been a general increase in the number of suicides following bariatric surgery, with clusters of cases being more frequently reported in 2007 and 2010, and especially so in 2010, where a single study (Tindle et al., 2010) [13] reported a total of 31 suicides. More recently, in 2015–2017, there was an increase in the number of suicides as well, with a single study reporting 17 suicides (Laggeros et al., 2017) [46]. Given the risk of suicide associated with bariatric surgery and the incidence of psychiatric disorders among individuals undergoing bariatric surgery, it is important to have a multi-disciplinary team caring for these individuals. Based on the best practice guidelines, it is of importance to have a psychiatrist, psychologist and social worker as part of the psychosocial care team [90] and it is also essential for these healthcare professionals to have prior experience with working with such patients. Some of the commonly used questionnaires used for psychiatric assessment include the Beck-Depression Inventory, the Symptom Checklist-90-Revised (SCL-90-R), the Eating Disorder Inventory-2, Beck Anxiety Inventory and the Eating Disorders Examination (EDE-Q). Psychological interventions, in particular cognitive behavioral therapy, have been most widely used in the treatment, and patients routinely attend up to twelve sessions.
Our current study also identified the mean body mass index (BMI) as well as the duration of follow-up to be significant moderators of the heterogeneity found in the pooled prevalence for mortality. The fact that body mass index (BMI) mediates the heterogeneity of the pooled prevalence is not surprising given that a previous study by Padwal et al. (2013) [91] tried to determine the importance of BMI as a mortality predictor. Padwal et al. (2013) [91] found that BMI did have an effect on the absolute rate of mortality and in their study, the odds ratio computed was 1.03. In the current meta-analytic study, the duration of follow-up was found to be a significant moderator and we hypothesize that a longer-term follow-up would affect the mortality measures, given that there are short-term and longer-term causes that could lead to mortality (Cardoso et al., 2017) [11].
There are several strengths of this current review. We comprehensively searched through the literature and looked at all studies that have reported mortality as well as suicide, and we have included studies that reported both statistics, in order to compare the overall pooled prevalence rates. Meta-analytical regression analysis as well as subgroup analysis were performed. However, the current study has several inherent limitations. These include 50 non-English language papers and 58 studies with unclear or unknown causes of mortality listed that were excluded for ease of analysis. In addition, suicide data amongst the analysed papers is also sparse, with data about the demographics, reasons, and time from surgery being generally available. Also, most studies failed to report how they managed to obtain information about deaths (such as whether they screened death records, etc.). Additionally, deaths from alcoholic cirrhosis, drug overdoses, poisonings, and accidents not explicitly stated as suicide were excluded from analysis. Most papers analysed also listed low rates of long-term follow-up. Subgroup analysis was performed using the longest follow-up period recorded as most studies did not state clear default rates and average follow-up duration for extraction. It is possible that suicide and mortality occur amongst subjects lost to follow-up, which may further increase the pooled prevalence of suicide and mortality as compared to the given results.

5. Conclusions

The current study computed the pooled prevalence of all-cause mortality as well as that of suicide among cohorts with reported suicide following bariatric surgery. The findings from the current meta-analysis have resultant clinical implications. There is a need for a multi-disciplinary team to look into the psychological well-being of bariatric patients pre and postoperatively.

Author Contributions

R.B.C.L., M.W.B.Z. & R.C.M.H. conceived of the meta-analytical study. R.B.C.L. and M.W.B.Z. extracted the literature and the data from the published literature and performed the analysis. R.B.C.L. wrote the first draft of the manuscript, which was further amended by M.W.B.Z. and R.C.M.H.


This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.


  1. World Health Organization. Obesity. 2017. Available online: (assessed on 27 April 2017).
  2. Sanjeev, S.; Raed, H. Psychiatric Care in Severe Obesity: An Interdisciplinary Guide to Integrated Care, 1st ed.; Springer: Berlin, Germany, 2017. [Google Scholar]
  3. Rajan, T.M.; Menon, V. Psychiatric disorders and obesity: A review of association studies. J. Postgrad. Med. 2017, 63, 182–190. [Google Scholar] [PubMed]
  4. Global Strategy on Diet, Physical Activity and Health. World Health Organization. 2017. Available online: (assessed on 27 April 2017).
  5. Senger, E. Bariatric surgery guidelines in need of revision, experts argue. CMAJ 2011, 183, E234. [Google Scholar] [CrossRef] [PubMed]
  6. Maggard, M.A.; Shugarman, L.R.; Suttorp, M.; Maglione, M.; Sugerman, H.J.; Livingston, E.H.; Nguyen, N.T.; Li, Z.; Mojica, W.A.; Hilton, L. Meta-analysis: Surgical treatment of obesity. Ann. Intern. Med. 2005, 142, 547–559. [Google Scholar] [CrossRef] [PubMed]
  7. Angrisani, L.; Santonicola, A.; Iovino, P.; Formisano, G.; Buchwald, H.; Scopinaro, N. Bariatric Surgery Worldwide 2013. Obes. Surg. 2015, 25, 1822–1832. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  8. Slomski, A. Bariatric Surgery Has Durable Effects in Controlling Diabetes. JAMA 2017, 317, 1615. [Google Scholar] [CrossRef] [PubMed]
  9. Tirado, R.; Masdeu, M.J.; Vigil, L.; Rigla, M.; Luna, A.; Rebasa, P.; Pareja, R.; Hurtado, M.; Caixàs, A. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea. Obes. Surg. 2017, 27, 2338–2346. [Google Scholar] [CrossRef] [PubMed]
  10. Neff, K.J.; Baud, G.; Raverdy, V.; Caiazzo, R.; Verkindt, H.; Noel, C.; le Roux, C.W.; Pattou, F. Renal Function and Remission of Hypertension After Bariatric Surgery: A 5-Year Prospective Cohort Study. Obes. Surg. 2017, 27, 613–619. [Google Scholar] [CrossRef] [PubMed]
  11. Cardoso, L.; Rodrigues, D.; Gomes, L.; Carrilho, F. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes. Metab. 2017. [Google Scholar] [CrossRef] [PubMed]
  12. Peterhänsel, C.; Petroff, D.; Klinitzke, G.; Kersting, A.; Wagner, B. Risk of completed suicide after bariatric surgery: A systematic review. Obes. Rev. 2013, 14, 369–382. [Google Scholar] [CrossRef] [PubMed]
  13. Tindle, H.A.; Omalu, B.; Courcoulas, A.; Marcus, M.; Hammers, J.; Kuller, L.H. Risk of suicide after long-term follow-up from bariatric surgery. Am. J. Med. 2010, 123, 1036–1042. [Google Scholar] [CrossRef] [PubMed]
  14. Hensel, J.; Selvadurai, M.; Anvari, M.; Taylor, V. Mental Illness and psychotropic medication use among people assessed for bariatric surgery in Ontario, Canada. Obes. Surg. 2016, 26, 1531–1536. [Google Scholar] [CrossRef] [PubMed]
  15. Yen, Y.C.; Huang, C.K.; Tai, C.M. Psychiatric aspects of bariatric surgery. Curr. Opin. Psychiatry 2014, 27, 374–379. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  16. Yusufov, M.; Dalrymple, K.; Bernstein, M.H.; Walsh, E.; Rosenstein, L.; Chelminski, I.; Zimmerman, M. Body mass index, depression, and suicidality: The role of self-esteem in bariatric surgery candidates. J. Affect. Disord. 2017, 208, 238–247. [Google Scholar] [CrossRef] [PubMed]
  17. Mitchell, J.E.; Crosby, R.; de Zwaan, M.; Engel, S.; Roerig, J.; Steffen, K.; Gordon, K.H.; Karr, T.; Lavender, J.; Wonderlich, S. Possible risk factors for increased suicide following bariatric surgery. Obesity 2013, 21, 665–672. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  18. Ho, R.C.; Ong, H.S.; Kudva, K.G.; Cheung, M.W.; Mak, A. How to critically appraise and apply meta-analyses in clinical practice. Int. J. Rheum. Dis. 2010, 13, 294–299. [Google Scholar] [CrossRef] [PubMed]
  19. Cheung, M.W.; Ho, R.C.; Lim, Y.; Mak, A. Conducting a meta-analysis: Basics and good practices. Int. J. Rheum. Dis. 2012, 15, 129–135. [Google Scholar] [CrossRef] [PubMed]
  20. Loh, A.Z.; Tan, J.S.; Zhang, M.W.; Ho, R.C. The Global Prevalence of Anxiety and Depressive Symptoms among Caregivers of Stroke Survivors. J. Am. Med. Dir. Assoc. 2017, 18, 111–116. [Google Scholar] [CrossRef] [PubMed]
  21. Ho, R.C.; Ong, H.; Thiaghu, C.; Lu, Y.; Ho, C.S.; Zhang, M.W. Genetic Variants That Are Associated with Neuropsychiatric Systemic Lupus Erythematosus. J. Rheumatol. 2016, 43, 541–551. [Google Scholar] [CrossRef] [PubMed]
  22. Lu, Y.; Andiappan, A.K.; Lee, B.; Ho, R.; Lim, T.K.; Kuan, W.S.; Goh, D.Y.T.; Mahadevan, M.; Sim, T.B.; Wang, D.Y.; et al. Neuropeptide Y associated with asthma in young adults. Neuropeptides 2016, 59, 117–121. [Google Scholar] [CrossRef] [PubMed]
  23. Puthran, R.; Zhang, M.W.; Tam, W.W.; Ho, R.C. Prevalence of depression amongst medical students: A meta-analysis. Med. Educ. 2016, 50, 456–468. [Google Scholar] [CrossRef] [PubMed]
  24. Aarts, E.O.; Dogan, K.; Koehestanie, P.; Aufenacker, T.J.; Janssen, I.M.; Berends, F.J. Long-term results after laparoscopic adjustable gastric banding: A mean fourteen year follow-up study. Surg. Obes. Relat. Dis. 2014, 10, 633–640. [Google Scholar] [CrossRef] [PubMed]
  25. Adams, T.D.; Gress, R.E.; Smith, S.C.; Halverson, R.C.; Simper, S.C.; Rosamond, W.D.; LaMonte, M.J.; Stroup, A.M.; Hunt, S.C. Long-term mortality after gastric bypass surgery. N. Engl. J. Med. 2007, 357, 753–761. [Google Scholar] [CrossRef] [PubMed]
  26. Adams, T.D.; Davidson, L.E.; Litwin, S.E.; Kolotkin, R.L.; LaMonte, M.J.; Pendleton, R.C.; Strong, M.B.; Vinik, R.; Wanner, N.A.; Hopkins, P.N.; et al. Health benefits of gastric bypass surgery after 6 years. JAMA 2012, 308, 1122–1131. [Google Scholar] [CrossRef] [PubMed]
  27. Arapis, K.; Chosidow, D.; Lehmann, M.; Bado, A.; Polanco, M.; Kamoun-Zana, S.; Pelletier, A.L.; Kousouri, M.; Marmuse, J.-P. Long-term results of adjustable gastric banding in a cohort of 186 super-obese patients with a BMI ≥ 50 kg/m2. J. Visc. Surg. 2012, 149, e143–e152. [Google Scholar] [CrossRef] [PubMed]
  28. Arman, G.A.; Himpens, J.; Dhaenens, J.; Ballet, T.; Vilallonga, R.; Leman, G. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg. Obes. Relat. Dis. 2016, 12, 1778–1786. [Google Scholar] [CrossRef] [PubMed]
  29. Biertho, L.; Biron, S.; Hould, F.S.; Lebel, S.; Marceau, S.; Marceau, P. Is biliopancreatic diversion with duodenal switch indicated for patients with body mass index <50 kg/m2? Surg. Obes. Relat. Dis. 2010, 6, 508–514. [Google Scholar] [CrossRef] [PubMed]
  30. Bolckmans, R.; Himpens, J. Long-term (>10 years) Outcome of the Laparoscopic Biliopancreatic Diversion with Duodenal Switch. Ann. Surg. 2016, 264, 1029–1037. [Google Scholar] [CrossRef] [PubMed]
  31. Busetto, L.; Mirabelli, D.; Petroni, M.L.; Mazza, M.; Favretti, F.; Segato, G.; Chiusolo, M.; Merletti, F.; Balzola, F.; Enzi, G. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg. Obes. Relat. Dis. 2007, 3, 496–502. [Google Scholar] [CrossRef] [PubMed]
  32. Busetto, L.; De Stefano, F.; Pigozzo, S.; Segato, G.; De Luca, F.; Favretti, F. Long-term cardiovascular risk and coronary events in morbidly obese patients treated with laparoscopic gastric banding. Surg. Obes. Relat. Dis. 2014, 10, 112–120. [Google Scholar] [CrossRef] [PubMed]
  33. Cadière, G.-B.; Himpens, J.; Bazi, M.; Cadière, B.; Vouche, M.; Capelluto, E.; Dapri, G. Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic gastric bypass similar in terms of results? Obes. Surg. 2011, 21, 692–698. [Google Scholar] [CrossRef] [PubMed]
  34. Capella, J.F.; Capella, R.F. The weight reduction operation of choice: Vertical banded gastroplasty or gastric bypass? Am. J. Surg. 1996, 171, 74–79. [Google Scholar] [CrossRef]
  35. Carelli, A.M.; Youn, H.A.; Kurian, M.S.; Ren, C.J.; Fielding, G.A. Safety of the laparoscopic adjustable gastric band: 7-year data from a U.S. center of excellence. Surg. Endosc. 2010, 24, 1819–1823. [Google Scholar] [CrossRef] [PubMed]
  36. Christou, N.V.; Look, D.; Maclean, L.D. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann. Surg. 2006, 244, 734–740. [Google Scholar] [CrossRef] [PubMed]
  37. Cobourn, C.; Chapman, M.A.; Ali, A.; Amrhein, J. Five-year weight loss experience of outpatients receiving laparoscopic adjustable gastric band surgery. Obes. Surg. 2013, 23, 903–910. [Google Scholar] [CrossRef] [PubMed]
  38. Diniz Mde, F.; Moura, L.D.; Kelles, S.M.; Diniz, M.T. Long-term mortality of patients submitted to Roux-en-Y gastric bypass in Public Health System: High prevalence of alcoholic cirrhosis and suicides. Arq. Bras. Cir. Dig. 2013, 26 (Suppl. 1), 53–56. [Google Scholar] [PubMed]
  39. Goldfeder, L.B.; Ren, C.J.; Gill, J.R. Fatal complications of bariatric surgery. Obes. Surg. 2006, 16, 1050–1056. [Google Scholar] [CrossRef] [PubMed]
  40. Gribsholt, S.B.; Thomsen, R.W.; Svensson, E.; Richelsen, B. Overall and cause-specific mortality after Roux-en-Y gastric bypass surgery: A nationwide cohort study. Surg. Obes. Relat. Dis. 2017, 13, 581–587. [Google Scholar] [CrossRef] [PubMed]
  41. Higa, K.D.; Boone, K.B.; Ho, T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients—What have we learned? Obes. Surg. 2000, 10, 509–513. [Google Scholar] [CrossRef] [PubMed]
  42. Himpens, J.; Cadière, G.B.; Bazi, M.; Vouche, M.; Cadière, B.; Dapri, G. Long-term outcomes of laparoscopic adjustable gastric banding. Arch. Surg. 2011, 146, 802–807. [Google Scholar] [CrossRef] [PubMed]
  43. Himpens, J.; Verbrugghe, A.; Cadière, G.B.; Everaerts, W.; Greve, J.W. Long-term results of laparoscopic Roux-en-Y Gastric bypass: Evaluation after 9 years. Obes. Surg. 2012, 22, 1586–1593. [Google Scholar] [CrossRef] [PubMed]
  44. Bruschi Kelles, S.M.; Diniz, M.F.; Machado, C.J.; Barreto, S.M. Mortality rate after open Roux-in-Y gastric bypass: A 10-year follow-up. Braz. J. Med. Biol. Res. 2014, 47, 617–625. [Google Scholar] [CrossRef]
  45. Kral, J.G.; Görtz, L.; Hermansson, G.; Wallin, G.S. Gastroplasty for obesity: Long-term weight loss improved by vagotomy. World J. Surg. 1993, 17, 75–78. [Google Scholar] [CrossRef] [PubMed]
  46. Lagerros, Y.T.; Brandt, L.; Hedberg, J.; Sundbom, M.; Bodén, R. Suicide, Self-harm, and Depression after Gastric Bypass Surgery: A Nationwide Cohort Study. Ann. Surg. 2017, 265, 235–243. [Google Scholar] [CrossRef] [PubMed]
  47. Lemanu, D.P.; Singh, P.P.; Rahman, H.; Hill, A.G.; Babor, R.; MacCormick, A.D. Five-year results after laparoscopic sleeve gastrectomy: A prospective study. Surg. Obes. Relat. Dis. 2015, 11, 518–524. [Google Scholar] [CrossRef] [PubMed]
  48. MacDonald, K.G., Jr.; Long, S.D.; Swanson, M.S.; Brown, B.M.; Morris, P.; Dohm, G.L.; Pories, W.J. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J. Gastrointest. Surg. 1997, 1, 213–220. [Google Scholar] [CrossRef]
  49. MacLean, L.D.; Rhode, B.M.; Nohr, C.W. Late outcome of isolated gastric bypass. Ann. Surg. 2000, 231, 524–528. [Google Scholar] [CrossRef] [PubMed]
  50. Marceau, P.; Biron, S.; Hould, F.-S.; Lebel, S.; Marceau, S.; Lescelleur, O.; Biertho, L.; Simard, S. Duodenal switch: Long-term results. Obes. Surg. 2007, 17, 1421–1430. [Google Scholar] [CrossRef] [PubMed]
  51. Marceau, P.; Biron, S.; Hould, F.-S.; Lebel, S.; Marceau, S.; Lescelleur, O.; Biertho, L.; Simard, S. Duodenal switch improved standard biliopancreatic diversion: A retrospective study. Surg. Obes. Relat. Dis. 2009, 5, 43–47. [Google Scholar] [CrossRef] [PubMed]
  52. Marceau, P.; Biron, S.; Marceau, S.; Hould, F.S.; Lebel, S.; Lescelleur, O.; Biertho, L.; Simard, S.; Kral, J.G. Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion. Obes. Surg. 2015, 25, 1584–1593. [Google Scholar] [CrossRef] [PubMed]
  53. Marsk, R.; Näslund, E.; Freedman, J.; Tynelius, P.; Rasmussen, F. Bariatric surgery reduces mortality in Swedish men. Br. J. Surg. 2010, 97, 877–883. [Google Scholar] [CrossRef] [PubMed]
  54. McPhee, J.; Khlyavich Freidl, E.; Eicher, J.; Zitsman, J.L.; Devlin, M.J.; Hildebrandt, T.; Sysko, R. Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study. Eur. Eat. Disord. Rev. 2015, 23, 517–523. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  55. Mitchell, J.E.; Lancaster, K.L.; Burgard, M.A.; Howell, L.M.; Krahn, D.D.; Crosby, R.D.; Wonderlich, S.A.; Gosnell, B.A. Long-term follow-up of patients’ status after gastric bypass. Obes. Surg. 2001, 11, 464–468. [Google Scholar] [CrossRef] [PubMed]
  56. Näslund, E.; Granström, L.; Stockeld, D.; Backman, L. Marlex Mesh Gastric Banding: A 7–12 Year Follow-up. Obes. Surg. 1994, 4, 269–273. [Google Scholar] [CrossRef] [PubMed]
  57. Näslund, E.; Backman, L.; Granström, L.; Stockeld, D. Does the Size of the Upper Pouch Affect Weight Loss after Vertical Banded Gastroplasty. Obes. Surg. 1995, 5, 378–381. [Google Scholar] [CrossRef] [PubMed]
  58. Nocca, D.; Krawczykowsky, D.; Bomans, B.; Noël, P.; Picot, M.C.; Blanc, P.M.; de Seguin de Hons, C.; Millat, B.; Gagner, M.; Monnier, L.; et al. A prospective multicenter study of 163 sleeve gastrectomies: Results at 1 and 2 years. Obes. Surg. 2008, 18, 560–565. [Google Scholar] [CrossRef] [PubMed]
  59. Obeid, N.R.; Malick, W.; Concors, S.J.; Fielding, G.A.; Kurian, M.S.; Ren-Fielding, C.J. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. Surg. Obes. Relat. Dis. 2016, 12, 11–20. [Google Scholar] [CrossRef] [PubMed]
  60. O’Brien, P.E.; MacDonald, L.; Anderson, M.; Brennan, L.; Brown, W.A. Long-term outcomes after bariatric surgery: Fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann. Surg. 2013, 257, 87–94. [Google Scholar] [CrossRef] [PubMed]
  61. Omalu, B.I.; Ives, D.G.; Buhari, A.M.; Lindner, J.L.; Schauer, P.R.; Wecht, C.H.; Kuller, L.H. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch. Surg. 2007, 142, 923–928. [Google Scholar] [CrossRef] [PubMed]
  62. Peeters, A.; O’Brien, P.E.; Laurie, C.; Anderson, M.; Wolfe, R.; Flum, D.; MacInnis, R.J.; English, D.R.; Dixon, J. Substantial intentional weight loss and mortality in the severely obese. Ann. Surg. 2007, 246, 1028–1033. [Google Scholar] [CrossRef] [PubMed]
  63. Pekkarinen, T.; Koskela, K.; Huikuri, K.; Mustajoki, P. Long-term Results of Gastroplasty for Morbid Obesity: Binge-Eating as a Predictor of Poor Outcome. Obes. Surg. 1994, 4, 248–255. [Google Scholar] [CrossRef] [PubMed]
  64. Pories, W.J.; MacDonald, K.G., Jr.; Flickinger, E.G.; Dohm, G.L.; Sinha, M.K.; Barakat, H.A.; May, H.J.; Khazanie, P.; Swanson, M.S.; Morgan, E.; et al. Is type II diabetes mellitus (NIDDM) a surgical disease? Ann. Surg. 1992, 215, 633–642; discussion 643. [Google Scholar] [CrossRef] [PubMed]
  65. Pories, W.J.; Swanson, M.S.; MacDonald, K.G.; Long, S.B.; Morris, P.G.; Brown, B.M.; Barakat, H.A.; de Ramon, R.A.; Israel, G.; Dolezal, J.M.; et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann. Surg. 1995, 222, 339–350; discussion 350–352. [Google Scholar] [CrossRef] [PubMed]
  66. Powers, P.S.; Boyd, F.; Blair, C.R.; Stevens, B.; Rosemurgy, A. Psychiatric Issues in Bariatric Surgery. Obes. Surg. 1992, 2, 315–325. [Google Scholar] [CrossRef] [PubMed]
  67. Powers, P.S.; Rosemurgy, A.; Boyd, F.; Perez, A. Outcome of gastric restriction procedures: Weight, psychiatric diagnoses, and satisfaction. Obes. Surg. 1997, 7, 471–477. [Google Scholar] [CrossRef] [PubMed]
  68. Rawlins, L.; Rawlins, M.P.; Brown, C.C.; Schumacher, D.L. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg. Obes. Relat. Dis. 2013, 9, 21–25. [Google Scholar] [CrossRef] [PubMed]
  69. Van Rutte, P.W.; Smulders, J.F.; de Zoete, J.P.; Nienhuijs, S.W. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br. J. Surg. 2014, 101, 661–668. [Google Scholar] [CrossRef] [PubMed]
  70. Shah, K.; Johnny Nergard, B.; Stray Frazier, K.; Geir Leifsson, B.; Aghajani, E.; Gislason, H. Long-term effects of laparoscopic Roux-en-Y gastric bypass on metabolic syndrome in patients with morbid obesity. Surg. Obes. Relat. Dis. 2016, 12, 1449–1456. [Google Scholar] [CrossRef] [PubMed]
  71. Sieber, P.; Gass, M.; Kern, B.; Peters, T.; Slawik, M.; Peterli, R. Five-year results of laparoscopic sleeve gastrectomy. Surg. Obes. Relat. Dis. 2014, 10, 243–249. [Google Scholar] [CrossRef] [PubMed]
  72. Skroubis, G.; Karamanakos, S.; Sakellaropoulos, G.; Panagopoulos, K.; Kalfarentzos, F. Comparison of early and late complications after various bariatric procedures: Incidence and treatment during 15 years at a single institution. World J. Surg. 2011, 35, 93–101. [Google Scholar] [CrossRef] [PubMed]
  73. Smith, S.C.; Goodman, G.N.; Edwards, C.B. Roux-en-Y Gastric Bypass: A 7-year Retrospective Review of 3,855 Patients. Obes. Surg. 1995, 5, 314–318. [Google Scholar] [CrossRef] [PubMed]
  74. Smith, S.C.; Edwards, C.B.; Goodman, G.N.; Halversen, R.C.; Simper, S.C. Open vs laparoscopic Roux-en-Y gastric bypass: Comparison of operative morbidity and mortality. Obes. Surg. 2004, 14, 73–76. [Google Scholar] [CrossRef] [PubMed]
  75. Suter, M.; Calmes, J.M.; Paroz, A.; Giusti, V. A 10-year experience with laparoscopic gastric banding for morbid obesity: High long-term complication and failure rates. Obes. Surg. 2006, 16, 829–835. [Google Scholar] [CrossRef] [PubMed]
  76. Suter, M.; Donadini, A.; Romy, S.; Demartines, N.; Giusti, V. Laparoscopic Roux-en-Y gastric bypass: Significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann. Surg. 2011, 254, 267–273. [Google Scholar] [CrossRef] [PubMed]
  77. Svenheden, K.E.; Akesson, L.A.; Holmdahl, C.; Näslund, I. Staple disruption in vertical banded gastroplasty. Obes. Surg. 1997, 7, 136–138. [Google Scholar] [CrossRef] [PubMed]
  78. Tao, W.; Plecka-Östlund, M.; Lu, Y.; Mattsson, F.; Lagergren, J. Causes and risk factors for mortality within 1 year after obesity surgery in a population-based cohort study. Surg. Obes. Relat. Dis. 2015, 11, 399–405. [Google Scholar] [CrossRef] [PubMed]
  79. Thereaux, J.; Corigliano, N.; Poitou, C.; Oppert, J.M.; Czernichow, S.; Bouillot, J.L. Five-year weight loss in primary gastric bypass and revisional gastric bypass for failed adjustable gastric banding: Results of a case-matched study. Surg. Obes. Relat. Dis. 2015, 11, 19–25. [Google Scholar] [CrossRef] [PubMed]
  80. Van de Weijgert, E.J.; Ruseler, C.H.; Elte, J.W. Long-term follow-up after gastric surgery for morbid obesity: Preoperative weight loss improves the long-term control of morbid obesity after vertical banded gastroplasty. Obes. Surg. 1999, 9, 426–432. [Google Scholar] [CrossRef] [PubMed]
  81. Werling, M.; Fändriks, L.; Björklund, P.; Maleckas, A.; Brandberg, J.; Lönroth, H.; Le Roux, C.W.; Olbers, T. Long-term results of a randomized clinical trial comparing Roux-en-Y gastric bypass with vertical banded gastroplasty. Br. J. Surg. 2013, 100, 222–230. [Google Scholar] [CrossRef] [PubMed]
  82. Yale, C.E. Gastric surgery for morbid obesity. Complications and long-term weight control. Arch. Surg. 1989, 124, 941–946. [Google Scholar] [CrossRef] [PubMed]
  83. Zitsman, J.L.; DiGiorgi, M.F.; Fennoy, I.; Kopchinski, J.S.; Sysko, R.; Devlin, M.J. Adolescent laparoscopic adjustable gastric banding (LAGB): Prospective results in 137 patients followed for 3 years. Surg. Obes. Relat. Dis. 2015, 11, 101–109. [Google Scholar] [CrossRef] [PubMed]
  84. Chang, S.H.; Stoll, C.R.; Song, J.; Varela, J.E.; Eagon, C.J.; Colditz, G.A. The effectiveness and risks of bariatric surgery: An updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2013, 149, 275–287. [Google Scholar] [CrossRef] [PubMed]
  85. Rottenstreich, A.; Keidar, A.; Yuval, J.B.; Abu-Gazala, M.; Khalaileh, A.; Elazary, R. Outcome of bariatric surgery in patients with type 1 diabetes mellitus: Our experience and reviewof the literature. Surg. Endosc. 2016, 30, 5428–5433. [Google Scholar] [CrossRef] [PubMed]
  86. Balla, A.; Batista Rodríguez, G.; Corradetti, S.; Balagué, C.; Fernández-Ananín, S.; Targarona, E.M. Outcomes after bariatric surgery according to large databases: A systematic review. Langenbecks Arch. Surg. 2017. [Google Scholar] [CrossRef] [PubMed]
  87. World Health Organization. Available online: (assessed on 6 September 2017).
  88. Adams, T.D.; Mehta, T.S.; Davidson, L.E.; Hunt, S.C. All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review. Curr. Atheroscler. Rep. 2015, 17, 74. [Google Scholar] [CrossRef] [PubMed]
  89. Roizblatt, A.; Roizblatt, D.; Soto-Aguilar, B.F. Suicide risk after bariatric surgery. Rev. Med. Chile 2016, 144, 1171–1176. [Google Scholar] [CrossRef] [PubMed]
  90. Greenberg, I.; Sogg, S.; Perna, F.M. Behavioral and psychological care in weight loss surgery: Best practice update. Obesity 2009, 17, 880–884. [Google Scholar] [CrossRef] [PubMed]
  91. Padwal, R.S.; Klarenbach, S.W.; Wang, X.; Sharma, A.M.; Karmali, S.; Birch, D.W.; Majumdar, S.R. A simple prediction rule for all-cause mortality in a cohort eligible for bariatric surgery. JAMA Surg. 2013, 148, 1109–1115. [Google Scholar] [CrossRef] [PubMed]
Figure 1. Flow chart showing the selection of the studies.
Figure 1. Flow chart showing the selection of the studies.
Ijerph 15 01519 g001
Table 1. Characteristics of the included studies.
Table 1. Characteristics of the included studies.
Author and YearStudy TypeSample Size (n)Mortality (n)Suicide (n)Mean Age% Male% FemaleMean BMIProcedureCountryLongest Follow-Up (Month)
1Aarts et al. 2014 [24]Prospective Cohort Study20161370.230.7745.6Laparoscopic adjustable gastric bandingThe Netherlands216
2Adams et al. 2007 [25]Retrospective Cohort Study99492882139.30.140.8644.9Roux- En-Y Gastric BypassUSA216
3Adams et al. 2012 [26]Prospective Cohort Study115612442.50.180.8245.9Roux- En-Y Gastric BypassUSA72
4Arapis et al. 2017 [27]Prospective Cohort Study8976139.50.130.8739.5Laproscopic adjustable gastric bandingFrance228
5Arman et al. 2016 [28]Prospective Cohort Study1062138.50.260.7438.5Laproscopic Sleeve GastrectomyBelgium140
6Biertho et al. 2010 [29]Retrospective Cohort Study81025541.10.210.7944.2Biliopancreatic diversion with duodenal switchCanada201
7Bolckmans et al. 2016 [30]Retrospective Cohort Study1539140.60.160.8446.4Biliopancreatic diversion with duodenal switchBelgium135
8Busetto et al. 2007 [31]Case control study8218138.20.240.7648.6Laproscopic adjustable gastric bandingItaly120
9Busetto et al. 2014 [32]Prospective Cohort Study31815138.60.180.8246.7Laproscopic adjustable gastric bandingItaly120
10Cadiere et al. 2011 [33]Retrospective Cohort Study47011400.1660.834NALaproscopic gastric bypassBelgium66
11Capella et al. 1996 [34]Prospective Cohort Study88883370.1780.82252Vertical banded gastroplasty/Vertical banded gastroplasty-Roux-en-y gastric bypassUSA60
12Carelli et al. 2010 [35]Retrospective Cohort Study2909101NA0.320.6845.27Laproscopic adjustable gastric bandingUSA60
13Christou et al. 2006 [36]Retrospective Cohort Study27282420.180.8248.1Roux- En-Y Gastric BypassCanadaNA
14Cobourn et al. 2013 [37]Retrospective Cohort Study281591430.180.8244.6Laproscopic Adjustable Gastric BandingCanada60
15Diniz et al. 2013 [38]Prospective Cohort Study2489239.70.250.7553Roux- En-Y Gastric BypassBrazilNA
16Goldfeder et al. 2006 [39]Retrospective Cohort Study1071071NANANANANAUSANA
17Girbsholt et al. 2016 [40]Retrospective Cohort Study9895911040.20.2170.78346Roux- En-Y Gastric BypassDenmark50
18Higa et al. 2000 [41]Prospective Cohort Study104051NA0.1740.82647.8Roux- En-Y Gastric BypassUSA12
19Himpens et al. 2011 [42]Prospective Cohort Study8231500.10.941.57Laproscopic Adjustable Gastric BandingBelgiumNA
20Himpens et al. 2012 [43]Prospective Cohort Study772138.90.20.840.3Laproscopic Roux-En-Y Gastric bypassBelgium112
21Kelles et al. 2014 [44]Prospective Cohort Study434482834.90.210.7942Roux- En-Y Gastric BypassBrazil120
22Kral et al. 1993 [45]Prospective Cohort Study6931380.180.8247Vertical Banded GastroplastySweden60
23Laggeros et al. 2017 [46]Retrospective Cohort Study22,539NA1741.30.7530.247NANASweden26
24Lemanu et al. 2015 [47]Prospective Cohort Study963146.90.1820.81850.7Laproscopic Sleeve GastrectomyNew Zealand60
25Macdonald et al. 1997 [48]Prospective Cohort Study15414141.90.2340.76650.6Roux- En-Y Gastric BypassUSA132
26Maclean et al. 2000 [49]Prospective Cohort Study27431NANANA43.2Isolated Gastric BypassCanadaNA
27Marceau et al. 2007 [50]Prospective Cohort Study142367640.1NANA51.5Duodenal SwitchCanada180
28Marceau et al. 2009 [51]Prospective Cohort Study686493NANANA48.3Biliopancreatic diversion with distal gastrectomy/Biliopancreatic diversion with duodenal switchCanada120
29Marceau et al. 2015 [52]Prospective Cohort Study26151239420.3070.69352Biliopancreatic diversionCanadaNA
30Marsk et al. 2010 [53]Case control study1216434NA10NANASwedenNA
31Mcphee et al. 2015 [54]Case control study20622NANANANALaproscopic sleeve gastrectomy/Laproscopic adjustable gastric bandingUSANA
32Mitchell et al. 2001 [55]Prospective Cohort Study788156.80.170.8343.8Gastric bypassUSA180
33Naslund et al. 1994 [56]Prospective Cohort Study3752370.180.8245.5Gastric bandingSweden120
34Naslund et al. 1995 [57]Prospective Cohort Study1583139.30.160.8444.7Vertical Banded GastroplastySwedenNA
35Nocca et al. 2007 [58]Prospective Cohort Study16311410.320.6845.9Laproscopic Sleeve GastrectomyFrance24
36N Obeid et al. 2015 [59]Prospective Cohort Study3289241.40.170.8347.5Roux- En-Y Gastric BypassUSA120
37O’Brien et al. 2013 [60]Prospective Cohort Study32274147.10.220.7843.8Laproscopic Adjustable Gastric BandingAustralia120
38Omalu et al. 2007 [61]Retrospective Cohort Study16,68344016480.1770.823NANAUSANA
39Peeters et al. 2007 [62]Cohort study96641470.230.7744.9Laproscopic Adjustable Gastric BandingAustraliaNA
40Pekkarinen et al. 1994 [63]Prospective Cohort Study3331360.330.6750Vertical Banded GastroplastyFinlandNA
41Pories et al. 1992 [64]Prospective Cohort Study515233NA0.150.85NAGreenville Gastric BypassUSA132
42Pories et al. 1995 [65]Prospective Cohort Study60834337.30.1680.832NAGreenville Gastric BypassUSA168
43Powers et al. 1992 [66]Prospective Cohort Study1002138.80.150.8547Vertical Banded GastroplastyUSANA
44Powers et al. 1007 [67]Prospective Cohort Study1315139.40.150.85NANAUSANA
45Rawlins et al. 2012 [68]Prospective Cohort Study5521440.30.765Laproscopic Sleeve GastrectomyUSA60
46Rutte et al. 2014 [69]Prospective Cohort Study10416142.50.290.7144.3Sleeve gastrectomyThe Netherlands60
47Shah et al. 2016 [70]Prospective Cohort Study379514142.40.210.7940.9Roux- En-Y Gastric BypassNorway60
48Sieber et al. 2013 [71]Prospective Cohort Study681143.10.220.7843Laproscopic Sleeve GastrectomySwitzerlandNA
49Skroubis et al. 2010 [72]Prospective Cohort Study116221236.30.260.7453Vertical Banded Gastroplasty/Laproscopic sleeve gastrectomy/Roux-en-y gastric bypass/Biliopancreatic diversionGreeceNA
50Smith et al. 1995 [73]Retrospective Cohort Study3855242NA0.110.89NARoux- En-Y Gastric BypassUSA84
51Smith et al. 2004 [74]Retrospective Cohort Study7792139.3NANA40.32Roux- En-Y Gastric BypassUSA29
52Suter et al. 2006 [75]Prospective Cohort Study31751380.1360.86443.5Laproscopic Adjustable Gastric BandingSwitzerland84
53Suter et al. 2011 [76]Prospective Cohort Study3799239.40.260.7446.3Roux- En-Y Gastric BypassSwitzerland84
54Svenheden et al. 1997 [77]Prospective Cohort Study9521NA0.210.7942.5Vertical Banded GastroplastySweden24
55Tao et al. 2014 [78]Retrospective Cohort Study22,487851NANANANAGastric bypass/Gastric Banding/Vertical Banded Gastroplasty/Laproscopic Sleeve Gastrectomy/Billiopancreatic Diversion with duodenal Switch/Jejunoileal bypassSweden12
56Thereaux et al. 2014 [79]Prospective Cohort Study3307143.40.0890.91146.9Laproscopic Roux-En-Y Gastric bypassFrance60
57Tindle et al. 2010 [13]Prospective Cohort Study16,683NA31480.1770.823NAVariousUSANA
58Van de Weijgert et al. 1999 [80]Prospective Cohort Study153101340.1310.86946Roux-en-Y Gastric Bypass/Vertical Banded GastroplastyThe Netherlands168
59Werling et al. 2012 [81]Randomized Controlled Study822144.90.280.7242.1Roux-en-Y Gastric Bypass/Vertical Banded GastroplastySweden120
60Yale 1989 [82]Prospective Cohort Study53795360.1620.83846.8Roux-en-Y GastroJejunostomy/Vertical Banded Gastroplasty/GastrogastrotomyUSA60
61Zitsman et al. 2014 [83]Prospective Cohort Study13721170.310.6948.3Laproscopic Adjustable Gastric BandingUSA60
Table 2. Meta-regression analysis on the sources of heterogeneity for the prevalence of mortality among bariatric surgery cohorts with reported suicide mortality.
Table 2. Meta-regression analysis on the sources of heterogeneity for the prevalence of mortality among bariatric surgery cohorts with reported suicide mortality.
ModeratorsNo. of Studies UsedSlopeStandard ErrorLower Limit (95% CI)Upper Limit (95% CI)Z Valuep Value
Mean Age50−0.023700.03244−0.087290.03988−0.730650.46499
Proportion of males54−0.012580.01069−0.033530.00838−1.176210.23951
Mean BMI490.0082840.034810.014610.151072.379800.01732 *
Longest follow-up interval440.011770.002710.006460.017084.345450.00001 *
* p < 0.05 is considered significant. Mean BMI and Follow-up interval are significant moderators.
Table 3. Subgroup analysis on the sources of heterogeneity for the prevalence of mortality among bariatric surgery cohorts with reported suicide mortality.
Table 3. Subgroup analysis on the sources of heterogeneity for the prevalence of mortality among bariatric surgery cohorts with reported suicide mortality.
PredictorNo. of StudiesPooled Prevalence (%)95% CIp-Value in between Group Comparison
Restrictive procedures251.40.9–2.30.309
Malabsorptive procedures242.41.8–3.3
Restrictive and/or Malabsorptive procedures61.60.6–4.1
Unspecified procedures62.50.6–9.2
Continent—North America282.11.5–2.90.380
Continent—South America22.41.3–4.5
Table 4. Subgroup analysis on the sources of heterogeneity for the prevalence of suicide.
Table 4. Subgroup analysis on the sources of heterogeneity for the prevalence of suicide.
PredictorNo. of StudiesPooled Prevalence (%)95% CIp-Value in between Group Comparison
Restrictive procedures250.50.3–0.80.131
Malabsorptive procedures240.30.2–0.4
Restrictive and/or Malabsorptive procedures60.30.1–1.0
Unspecified procedures60.20.1–0.3
Continent—North America280.30.2–0.50.878
Continent—South America20.30.1–1.4

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Lim, R.B.C.; Zhang, M.W.B.; Ho, R.C.M. Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis. Int. J. Environ. Res. Public Health 2018, 15, 1519.

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Lim RBC, Zhang MWB, Ho RCM. Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis. International Journal of Environmental Research and Public Health. 2018; 15(7):1519.

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Lim, Russell B.C., Melvyn W.B. Zhang, and Roger C.M. Ho. 2018. "Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis" International Journal of Environmental Research and Public Health 15, no. 7: 1519.

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