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1 Supplementary Online Content Arterburn DE, Olsen MK, Smith VA, Livingston EH, Van Scoyoc L, Yancy WS, Jr. Association Between Bariatric Surgery and Long-Term Survival. JAMA. doi: /jama efigure 1. Flow of Surgical Patients and Matched Patients From January 1, 2000, to September 30, 2011 efigure 2. Kaplan-Meier Estimated Mortality Curves of Early ( ) and Late ( ) Cohorts efigure 3. Kaplan-Meier Estimated Mortality Curves Stratified by Diabetes Status at Time of Surgery efigure 4. Kaplan-Meier Estimated Mortality Curves Stratified by Sex efigure 5. Kaplan-Meier Estimated Mortality Curves Stratified by Super Obesity (BMI >50) Status at Time of Surgery This supplementary material has been provided by the authors to give readers additional information about their work.
2 efigure 1. Flow of Surgical Patients and Matched Patients From January 1, 2000, to September 30, 2011 Removed n=15; never obese 2,752 Surgical Cases 1,447,165 individuals who were potential matches 2737 Surgical cases Removed n=179,992; no match on gender, BMI, age categories Removed n=32; no BMI 2,705 Surgical Cases Removed n=40; no valid bariatric surgery code or surgery was revision 2,665 Surgical Cases 1,267,173 individuals who were potential matches Removed n=120; medical exclusions* Removed n=639,626; no VISN match and medical exclusions Removed n=33; presurgical stay >5 days or no record of inpatient stay at date of surgery Removed n=12; no match within VISN on diabetes, race, gender, BMI, or DCG 2,545 Surgical Cases 2,512 Surgical Cases 2,500 Surgical Cases 627,547 individuals who were potential matches 7115 individuals in 3:1 match for a total of 7462 matches** (Note: 149 individuals (161 of the matches) were future cases and were censored at date of surgery) * Medical Exclusions (n=120; patients may have multiple exclusions) 2 Alzheimers/Dementia; 100 Cancer; 12 Crohn s/inflammatory bowel disease; 3 End-stage renal disease; 0 Gestational diabetes mellitus; 1 Peritoneal effusion; 6 Pregnancy ** Potential matches often had many BMI measurements over the study period, so each could match to more than one surgical patient.
3 efigure 2. Kaplan-Meier Estimated Mortality Curves of Early ( ) and Late ( ) Cohorts Figure 2A cohort (n=1,159 surgical patients and 3,452 matched patients); follow-up censored at December 31, Kaplan-Meier estimated mortality rates at 1, 5, and 8 years were 4.0%, 8.8%, and 13.0%, respectively, for the surgical patients and 2.1%, 11.8%, and 21.9 % for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p=0.047).
4 Figure 2B cohort (n=1,341 surgical patients and 4,010 matched patients); followup censored at December 31, Kaplan-Meier estimated mortality rates at 1, 5, and 8 years were 1.1%, 3.7%, and 7.4%, respectively, for the surgical patients and 1.4%, 9.0%, and 16.8% for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p<0.0001).
5 efigure 3. Kaplan-Meier Estimated Mortality Curves Stratified by Diabetes Status at Time of Surgery A. Diabetes Diagnosis at baseline (n=1,367 surgical patients and 4,077 matched patients). Kaplan-Meier estimated mortality rates at 1, 5, and 10 years were 2.8%, 7.6%, and 15.8%, respectively, for the surgical patients and 2.3%, 13.1%, and 30.5% for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p<0.0001).
6 B. No Diabetes Diagnosis at baseline (n=1,133 surgical patients and 3,385 matched patients). Kaplan-Meier estimated mortality rates at 1, 5, and 10 years were 2.0%, 4.9%, and 11.5%, respectively, for the surgical patients and 1.1%, 7.2%, and 16.6% for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p<0.001).
7 efigure 4. Kaplan-Meier Estimated Mortality Curves Stratified by Sex A. Male (n=1,849 surgical patients and 5,542 matched patients). Kaplan-Meier estimated mortality rates at 1, 5, and 10 years were 3.0%, 7.5%, and 16.3%, respectively, for the surgical patients and 2.1%, 12.6%, and 28.8% for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p<0.0001).
8 B. Female (n=651 surgical patients and 1,920 matched patients). Kaplan-Meier estimated mortality rates at 1, 5, and 10 years were 0.9%, 3.4%, and 6.9%, respectively, for the surgical patients and 0.7%, 3.9%, and 9.5% for the matches. A log-rank test stratified by matched group indicated no significant difference in the survival curves (p=0.24).
9 efigure 5. Kaplan-Meier Estimated Mortality Curves Stratified by Super Obesity (BMI >50) Status at Time of Surgery A. Super obese at baseline (n=730 surgical patients and n=2,130 matched patients). Kaplan-Meier estimated mortality rates at 1, 5, and 10 years were 4.9%, 10.5%, and 18.7%, respectively, for the surgical patients and 2.8%, 14.8%, and 29.6% for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p<0.0001).
10 B. Not super obese at baseline (n=1,770 surgical patients and n=5,332 matched patients). Kaplan-Meier estimated mortality rates at 1, 5, and 10 years were 1.4%, 4.6%, and 11.4%, respectively, for the surgical patients and 1.3%, 8.5%, and 21.0% for the matches. A log-rank test stratified by matched group indicated a significant difference in the survival curves (p<0.0001).
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