By: Jean Johnson for Reflux1“Medicare patients have a substantially higher risk of early death following bariatric surgery than previously suggested,” stated a Journal of the American Medical Association (JAMA) October 2005 press release summing up the results of a recent study. “And the risk of death is higher among men, older patients, and patients of surgeons who perform lower numbers of bariatric procedures.”
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Quick facts on obesity:
According to JAMA obesity is soon to become the leading cause of death in the United States.
The Department of Health and Human Services Centers for Disease Control (CDC) says more than 60 million Americans or 30 percent of the adults over age 20 are obese.
The CDC states that the percentage of young people with weight problems has more than tripled since 1980. Sixteen percent of the youth population between ages six and 19 are considered overweight.
For example, a 5’5” person that weighs 160 pounds has what’s known as a body mass index (BMI) of 26.6. The BMI scale shows that below 18.5 is underweight, while 18.5 to 24.9 is normal. Readings of 25.0 through 29.9 are overweight, and obese readings are a 30.0 and above.
To calculate your BMI, click here |
Early death? Males? Older people? And not-so-practiced surgeons? That’s quite a laundry list of complications for those who are so desperate about their weight that they are contemplating bariatric surgery on the stomach or intestine. Yet, with an overweight and obesity epidemic in full swing in the United States, many increasingly feel they have no alternative. Despite their best intentions, day after day comes to a close with that sluggish, hopeless feeling eating more calories than the body requires.
Added to the demoralization and general malaise felt by those unable to control their behavior around food is a host of physical problems associated with obesity. High blood pressure, adult onset diabetes, heart disease, stroke, gallbladder problems, osteoarthritis, sleep apnea and respiratory problems, some cancers like endometrial, breast and colon, and acid reflux or GERD (gasteroesophageal reflux disease) are just the most prominent on the list of what happens to our bodies when they are burdened with too much weight.
More, although the medical world is adept at informing patients of why they should control their weight not to mention explaining how it is done with healthy diets and reasonable activity levels, the profession has not been able to help those for whom over-eating is an emotional and behavioral issue. Even mental health experts that specialize in eating disorders confess success rates are few and far between. No wonder people are turning to the surgeons for help.
The recent study out of the University of Washington in Seattle, however, pointed to problems associated with bariatric surgery. Under the lead of David Flum, M.D., M.P.H., researchers analyzed early post-surgical deaths by examining records from more than 16,000 Medicare patients treated between 1997 and 2002 (a period during which the number of procedures increased three-fold).
Flum and his colleagues evaluated rates of death between all patients at one, three and twelve month intervals and found rates of 2.0, 2.8, and 4.6 percent respectively. (We did the math and 2 percent of 16,000 totals 320 souls while 4.6 percent equates to 736 people who lost their lives.)
Similarly, males were more likely to perish from bariatric surgery and death rates associated with patients over 65 years of age tended to be three times as high as rates for those under 65. Finally according to the JAMA statement, “the odds of death at 90 days were 1.6 times higher for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and co-existing illness index.”
Authors of the study underscored the idea that they were not trying to put the kibosh on bariatric surgery but instead were simply trying to point out that with numbers of procedures escalating it is incumbent on the medical profession to make sure it is moving into uncharted waters cautiously and responsibly.
“In conclusion, this study found that the risk of early post-surgical death among Medicare beneficiaries undergoing bariatric surgery was considerably higher than prior case series have suggested and was strongly associated with advancing age, male sex and lower surgeon volume,” writes Flum and his colleagues. “Those considering the role of bariatric procedures in older patients should balance this population-level risk of adverse outcomes against the anticipated benefits of the procedure. Directing care of older patients to surgeons who perform a higher volume of bariatric procedures in Medicare beneficiaries might be expected to improve outcomes in this high-risk population.”
As might be expected, the American Society for Bariatric Surgery (ASBS) commented on the Flum study as well as other recent research that has looked askance at outcomes associated with these surgeries. In addition to pointing out that mortality rates in California are lower than those Flum recounted in his study, ASBS spokespersons underscore that the physical health of the patients they treat is significantly jeopardized by the time they get to the last-ditch effort of surgery. “There is no other effective treatment for these severely obese people. Their co-morbidities [other physical problems and diseases] extend from the head to the toe and affect every organ in between.”
That said, as did the Flum study statement, ASBS concludes on the theme that indeed, this type of procedure is so delicate that it might require more practiced hands. “…bariatric surgery performed in an approved high volume Center of Excellence can provide profound improvements in obesity co-morbidities and quality of life, at a reasonable cost and with low rates of mortality and morbidity.”
In other words, even though there is considerable professional debate ongoing over bariatric surgery at the moment, those considering the treatment will be wise to shop around. We’re in an age of increasing specialization, so doing homework pays off. Look for someone who’s done a high number of the procedures.
For starters, going to ObesityHelp.com can help generate lists of surgeons along with their track records and personal testimonies of patients they have operated on. While the site asks surgeons to provide details on their experience, we found that many did not. Our suggestion in these cases is to call the office directly and ask the receptionists for the information. Most will either know or can found out and will return your call. Those that don’t seem to have the time probably aren’t very interested in your business and are best crossed off the list politely but firmly. Remember, knowledge is power, and studies have shown that patients who have faith in their physicians have better outcomes.
