Long‐Term Mortality and Cardiorenal Outcomes After Metabolic and Bariatric Surgery in Patients With Type 2 Diabetes and Obesity: A Retrospective Cohort Study

BACKGROUND: Although prior long-term studies have demonstrated benefits of metabolic and bariatric surgery (MBS) in patients with type 2 diabetes (T2D) and obesity, we aimed to further substantiate these associations using a large cohort with 10 years of follow-up. METHODS: ), and comorbidities to reduce confounding. The primary endpoint was all-cause mortality; secondary endpoints included major adverse cardiovascular events (MACEs) and major adverse kidney events (MAKEs) over 10 years. Cox proportional hazards models provided hazard ratios (HRs) with 95% confidence intervals (CIs), and Kaplan-Meier curves illustrated survival. RESULTS: Among 36,666 matched patient pairs (n = 73,332), all of whom had T2D and obesity, MBS was associated with significantly lower risks of all-cause mortality (HR 0.67 and 95% CI 0.63-0.71), MACEs (HR 0.67 and 95% CI 0.64-0.70), and MAKEs (HR 0.80 and 95% CI 0.76-0.84). Subgroup and sensitivity analyses confirmed these findings, and E-values supported the robustness of our findings, suggesting that it would require unmeasured confounders of substantial magnitude to nullify the observed associations. CONCLUSION: These results suggest durable associations with improved survival and reduced risks of cardiovascular and kidney outcomes, supporting MBS as a potentially effective treatment strategy for patients with type 2 diabetes and obesity. Continued prospective studies are warranted to further validate these associations and inform clinical decision-making in this high-risk population.