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Risks of gastric bypass
New study finds that patients 65 and older are more likely to die after
bariatric surgery than earlier believed
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Bypass surgery (KRT / Newsday)
Oct 18, 2005
BY RONI RABIN
STAFF WRITER
October 18, 2005, 8:22 PM EDT
Medicare patients who undergo weight-loss surgery face a considerably
higher risk of death than has been reported for other patients in
previous studies, with 2 percent dying within 30 days of surgery and
almost 5 percent dying within a year, a study of Medicare patients of
all ages found. Risks were amplified for men, those over 65 and
patients whose surgeons were less experienced in such surgery.
The American Society for Bariatric Surgeons and several earlier studies
have put the death rate from the surgery at 0.5 percent, or one in 200.
The paper was one of several published yesterday in the Journal of the
American Medical Association that reported sobering results about the
safety of weight- loss surgery.
Another study found patients, whose average age was 42 years old, were
twice as likely to end up in the hospital the year after gastric bypass
surgery as they were the year before, mostly to be treated for surgical
complications. That study, of more than 60,000 California patients,
found low death rates, with 0.3 percent of patients dying within 30
days of surgery and just under 1 percent dying within the year.
Despite the findings, an editorial accompanying the papers said
bariatric surgery "remains a fundamental therapy for morbidly obese
patients." Generally, patients must be at least 100 pounds overweight
to qualify for such surgery.
"Under the right circumstances, for an average or low-risk patient, the
mortality risk is very low," Dr. Bruce M. Wolfe, co-author of the
editorial, said in an interview, though he added, "The risk of
complications is very substantial, and the patients need to be
prepared."
Wolfe suggested that the poor outcomes of Medicare patients reflected a
much sicker, disabled population at significantly higher risk than the
average patient coming for weight-loss surgery.
But Dr. Dave Flum, lead author of the Medicare study and an associate
professor of surgery at University of Washington in Seattle, said the
low mortality rates that have been reported in the past for such
procedures were from "the best surgeons reporting the best results.
"This is a procedure that has real risks," Flum said of gastric bypass
surgery. "People should go into it with their eyes open.
"It's a high-risk operation, in a high-risk population, and there's
nothing wrong with saying that. The desire on the part of the surgical
community to minimize the risk is not well-advised."
His study of 16,155 Medicare patients found that men faced double the
risk of death than women, with 3.7 percent of men dying within a month
of the surgery compared to 1.5 percent of women, and 7.5 percent of men
dying within a year, compared to 3.7 percent of women.
The risk of dying also increased after age 65, so that almost 5 percent
of seniors who had the surgery died within 30 days and 11.1 percent
died within a year. Having an inexperienced surgeon also increased the
risk of death.
Concern about the risks does not appear to be discouraging Americans
from having bariatric surgery. A third paper in JAMA estimated that the
number of procedures has multiplied from 13,365 in 1998 to 72,177 by
2002, and was projected to reach 102,794 by 2003. The authors predicted
that about 130,000 procedures will be performed this year and that the
figure could reach 218,000 by 2010.
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TC