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

ABSTRACT 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 Surgery and nonsurgery groups were formed, and 1:1 propensity score matching was performed based on baseline characteristics including age, sex, body mass index (BMI ≥ 30 kg/m 2 ), 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.