Nutritional Independence After Bariatric Surgery: Recovery, Reintervention, and Long-Term Survival

Background: Nutritional failure requiring enteral or parenteral support is a serious complication of bariatric surgery, but its long-term course, likelihood of recovery, and relationship with survival are poorly characterized. Study Design: We conducted a single-center retrospective cohort study of adults requiring enteral or parenteral nutrition after bariatric surgery from 2004–2023. Nutritional independence was defined as discontinuation of all supplemental nutrition for ≥3 months. Kaplan-Meier and Cox proportional hazards analyses evaluated survival; a 12-month landmark analysis addressed immortal time bias. Results: Among 168 patients (85.1% female; median age 41.2 years; median BMI 47.3 kg/m²), 148 (88.1%) achieved nutritional independence during a median 11.6-year follow-up. Of these, 126 (85.1%) required endoscopic or surgical intervention, most commonly addressing gastrojejunal complications. Median time from nutritional support initiation to independence was 12.1 months. Among 165 patients alive and in follow-up at 12 months, mortality was 20.4% in 93 patients not yet independent versus 6.9% in 72 independent patients (HR 2.56, 95% CI 0.95 to 6.90, p=0.064). Of those not independent at 12 months, 74/93 (79.6%) subsequently achieved independence. Conclusions: Nutritional dependence after bariatric surgery was usually reversible, predominantly through endoscopic or surgical correction rather than nutritional support alone. Delayed nutritional independence was associated with numerically higher mortality, although this did not reach statistical significance. Timely, anatomy-specific intervention should therefore be prioritized to restore nutritional autonomy.