Death Found More Likely for Some After Obesity Surgery
Stomach stapling surgery to control obesity, which has grown dramatically in the United States, has a death rate for some groups of patients that is as much as five times higher than was previously thought, researchers report today.
About 4.6% of Medicare patients who undergo the surgery die the following year, with men and the elderly having the highest mortality, researchers from the University of Washington report today in the Journal of the American Medical Assn.
Researchers had previously believed the death rate to be less than 1%, about the same as that for surgery in general.
But a second, larger study by UCLA researchers showed an overall death rate of less than 1% among all Californians who underwent the surgery over a nine-year period.
That study also found a higher-than-expected rate of re-hospitalization after the procedure, suggesting that the surgery may not lower overall health costs.
Weight loss surgery “is the only effective intervention that we have, but it is a high-risk operation whose risks had not been really well described in previous studies,” said Dr. David R. Flum of the University of Washington, who led the study on Medicare patients.
Most of the Medicare patients were placed at high risk by their medical conditions, most of which were the direct result of their morbid obesity, he said
“It is not surprising that there is a higher risk in these patients, but we have to go back to the balance of how well they would be doing if they didn’t have the operation,” Flum said.
Even with these patients, their risks can be reduced by at least a third if the procedure is performed by highly experienced surgeons, Flum’s results showed.
And the risks can be further reduced if the patients undergo newer forms of weight loss surgery, such as laparoscopic banding of the stomach. That procedure, commonly called Lap-Band, has only one-tenth the death rate of older procedures and an equally low rate of complications, according to Dr. Carson Liu of the UCLA Medical Center.
Surgical intervention has become increasingly popular as the number of obese Americans has skyrocketed. Whereas dieting generally produces small, transient weight losses, surgery can produce dramatic, permanent losses of 100 pounds or more, accompanied by decreases in the risk of diabetes, heart disease and other ailments.
Dr. Heena P. Santry of the University of Chicago and her colleagues studied national records and concluded that the number of weight loss surgeries, collectively called bariatric surgical procedures, grew from 13,365 in 1998 to 72,177 in 2002. Estimates by the American Society for Bariatric Surgery are that the number will top 150,000 this year.
Even so, experts say, 0.6% of the Americans who could benefit from the surgery will actually receive it.
Flum and his colleagues studied 16,155 patients 35 and older who underwent bariatric surgery paid for by Medicare between 1997 and 2002.
The vast majority of the patients underwent invasive procedures in which surgeons created a small pouch in the stomach and connected it to a shortened length of intestine. The pouch constrains the amount of food that can be consumed and the shortened intestine limits the amount that can be absorbed by the body.
Flum and his colleagues found that men were almost twice as likely as women to die in the year after surgery.
Older patients -- those over 75 -- were as much as five times more likely to die as younger patients.
Those who had an inexperienced surgeon were 1.6 times as likely to die as those who had a more experienced one.
Causes of death included heart attacks, strokes, general shock to the system from the surgery, infections, malnutrition and bowel problems.
Flum and other experts cautioned that the Medicare patients had a variety of health problems caused, at least in part, by their disability, including diabetes, heart disease and osteoarthritis.
“These patients are very sick,” said Dr. Neil E. Hutcher, president of the American Society of Bariatric Surgeons.
Liu said, “Because of their problems, they are much more susceptible to heart attacks, strokes and pulmonary emboli.”
Flum speculated that, among the older patients, obesity had severely damaged the patients’ organs so that the surgically induced weight loss was not sufficient to restore health.
Speculation about the bad health of the Medicare patients was supported by the more positive results of the study run by UCLA’s Dr. David S. Zingmond and colleagues.
They studied all 60,077 Californians who had gastric bypass surgery from 1995 to 2004. Overall, 0.91% of the patients died within a year after the procedure.
They found that 19.3% of the patients were re-hospitalized in the year after surgery. In the year before the surgery, in contrast, 7.9% were hospitalized.
But Hutcher noted that about half the admissions were for minor problems, unrelated problems or problems that have been largely eliminated by newer surgical techniques.
