The top six risk factors for weight-loss surgery

Weight-loss surgery is safe and effective for most people, but complications do occur. Researchers reported Wednesday that they had devised a list of the top six risk factors. They are:

• The type of operation (gastric bypass or gastric band)

• Surgical technique (open or minimally invasive surgery)

• Patient gender

• Type of insurance

• Age

• Presence of type 2 diabetes

One or more of these risk factors may increase the risk of dying before leaving the hospital, said the authors of the study, from UC Irvine. The research was presented Wednesday at the annual meeting of the American Society for Metabolic & Bariatric Surgery.

“Bariatric surgery is safer than it has ever been, but there may be more we can do to make it even safer and improve the odds of survival for high-risk patients,” Dr. Ninh T. Nguyen, the lead author of the study and chief of gastrointestinal surgery at UC Irvine, said in a news release. “Doctors can use these risk factors to help in preoperative planning and to help patients better understand his or her individual risk.”

The analysis was based on data from 105,287 patients who underwent bariatric (weight-loss) surgery between 2002 and 2009 at various medical centers around the country. Having an open operation raised the risk of death almost fivefold as did having a gastric bypass compared to an adjustable gastric band procedure. The risk was tripled among men and among patients with Medicare coverage. The risk doubled in people age 60 or older and was increased by 50% in people with type 2 diabetes.

In other news from the meeting, which is being held in Orlando, Fla.:

• A study of almost 52,000 bariatric surgery patients found that those who were discharged from the hospital sooner than the national average stay of two days had higher rates of complications and deaths. People discharged on the same day as surgery were 13 times more likely to die compared to people who were discharged after two days, said the researchers from Stanford University. There is a drive to lower the costs of bariatic surgery by shortening hospital stays. But the lead author of the study, Dr. John Morton said: “We counsel our patients to avoid drive-through fast food, and also advise against drive-through gastric bypass.”

• The risk of heart attacks, strokes and death drops by as much as half after bariatric surgery, said researchers from Green Hospital System University Medical Center in South Carolina. The study reviewed data from 9,140 morbidly obese patients ages 40 to 79 who had either bariatric surgery or another type of surgery. After five years, the people who had bariatric surgery had heart attack rates about 50% lower than the control groups. They also had lower risks of stroke and death. Almost 85% of the baratric surgery patients had not had a heart attack five years after surgery.
• Having depression does not compromise the effectiveness of weight-loss surgery, researchers at the University of Michigan reported. People who had depression before surgery still had the same rates of weight-loss and quality-of-life improvements as people who were not depressed. However, patients with depression had a slightly higher risk of minor complications linked to surgery. One year after surgery, about 20% of the patients with depression had reduced their use of antidepressant medication.

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