weight-loss surgery - 5% dead within a year

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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.

*****

TC

The moral of the article appears to be that you should review the
credentials of your bariatric surgeon before getting the surgery, since
the original low mortality rates were those of the best surgeons.

I think, in the nearish term (next three years) you are going to see
more of a total quality / disclosure movement in the health care
industry in the US. Doctors and hospitals have been very reluctant to
do so, but I think mounting pressure and stories like this will
probably force the AMA to get into some kind of rating system for
surgeons and hospitals that goes beyond the current heart health
rankings. You'd think that the nation that spends the most on
healthcare, per capita, and the nation that drives the most innovation
in same would have had some kind of total quality management movement
years ago, particularly when faced with middle of the industrial world
healthcare outcomes.

Hollywood, who wonders how France spends a lot less but gets the best
results.


wrote:
http://www.newsday.com/news/health/n...health-big-pix

Risks of gastric bypass
New study finds that patients 65 and older are more likely to die after
bariatric surgery than earlier believed

Email this story

Printer friendly format



Graphics



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.

*****

TC

wrote:
The moral of the article appears to be that you should review the
credentials of your bariatric surgeon before getting the surgery, since
the original low mortality rates were those of the best surgeons.

I think, in the nearish term (next three years) you are going to see
more of a total quality / disclosure movement in the health care
industry in the US. Doctors and hospitals have been very reluctant to
do so, but I think mounting pressure and stories like this will
probably force the AMA to get into some kind of rating system for
surgeons and hospitals that goes beyond the current heart health
rankings. You'd think that the nation that spends the most on
healthcare, per capita, and the nation that drives the most innovation
in same would have had some kind of total quality management movement
years ago, particularly when faced with middle of the industrial world
healthcare outcomes.

Hollywood, who wonders how France spends a lot less but gets the best
results.

The thing is that in the US they don't actually come up with better
treatments to actually cure anything, they come up with the best
treatments that bring in the most money over the long term. That does
not include actually curing people but stringing them along on
expensive treatments that masks the symptoms and possibly even creates
more treatable conditions which then calls for more treatments, etc.

TC




wrote:
http://www.newsday.com/news/health/n...health-big-pix

Risks of gastric bypass
New study finds that patients 65 and older are more likely to die after
bariatric surgery than earlier believed

Email this story

Printer friendly format



Graphics



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.

*****

TC

wrote:

http://www.newsday.com/news/health/n...health-big-pix

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.

....

I'd like to see the numbers for folks who qualify for the
surgery but decide against. I doubt it's anything like 5%
dead a year later.

Talk about a "kill or cure" that isn't even necessarily a cure ...

wrote:
:: The moral of the article appears to be that you should review the
:: credentials of your bariatric surgeon before getting the surgery,
:: since the original low mortality rates were those of the best
:: surgeons.

If everyone follows this advice then the surgeries will go away become no
new people will get trained.

::
:: I think, in the nearish term (next three years) you are going to see
:: more of a total quality / disclosure movement in the health care
:: industry in the US. Doctors and hospitals have been very reluctant to
:: do so, but I think mounting pressure and stories like this will
:: probably force the AMA to get into some kind of rating system for
:: surgeons and hospitals that goes beyond the current heart health
:: rankings. You'd think that the nation that spends the most on
:: healthcare, per capita, and the nation that drives the most
:: innovation in same would have had some kind of total quality
:: management movement years ago, particularly when faced with middle
:: of the industrial world healthcare outcomes.

It will never happen. Such ratings would be career killers or they'd be
complete shams. The key is to enforce rigorous standards and to revoke
licences for too many failures within a certain period. You can't brand
people & institutions like that.

Roger Zoul wrote:
wrote:

:: The moral of the article appears to be that you should review the
:: credentials of your bariatric surgeon before getting the surgery,
:: since the original low mortality rates were those of the best
:: surgeons.

If everyone follows this advice then the surgeries will go away become no
new people will get trained.

Apprenticeships circumvent this issue. Assist in a
couple of dozen procedures, then have the senior
surgeon be there to surpervise a couple of dozen
procedures, and you have someone with over 40
procedures worth of experience. Surgery is not a
solo job.

:: I think, in the nearish term (next three years) you are going to see
:: more of a total quality / disclosure movement in the health care
:: industry in the US. Doctors and hospitals have been very reluctant to
:: do so, but I think mounting pressure and stories like this will
:: probably force the AMA to get into some kind of rating system for
:: surgeons and hospitals that goes beyond the current heart health
:: rankings. You'd think that the nation that spends the most on
:: healthcare, per capita, and the nation that drives the most
:: innovation in same would have had some kind of total quality
:: management movement years ago, particularly when faced with middle
:: of the industrial world healthcare outcomes.

It will never happen. Such ratings would be career killers or they'd be
complete shams. The key is to enforce rigorous standards and to revoke
licences for too many failures within a certain period. You can't brand
people & institutions like that.

They said that in California when restaurants were
required to post the letter grades from their most
recent inspection. There was an outcry among
restaurant owners that many would go out of business.
Far fewer when out of business than claimed, but the
cleanliness level in restaurants shot up dramatically.

States with a similar system for results of schools
will likely have the same to report.

It might never happen, but if it did happen I would
expect the result to track what happened to restaurants
in California. I seriously want Illinois to start
doing that. Seeing an A, B, C or locked door leaves
me much better informed than seeing no report until
the day the health department locks the door.

Doug Freyburger wrote:
:: wrote:
:::
:::
http://www.newsday.com/news/health/n...health-big-pix
:::
::: 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.
::
:: ...
::
:: I'd like to see the numbers for folks who qualify for the
:: surgery but decide against. I doubt it's anything like 5%
:: dead a year later.

Yeah, just think about all of the people you've know for years who are 100
lbs or more overweight. If they had the surgery the first year they were
overweight, they'd likely increase the chances of dying. If they wait years
and years, and get older, their odds of dying due to overweight go up, but
so do their chances of dying from this kind of surgery. Really kinda scary
odds....

::
:: Talk about a "kill or cure" that isn't even necessarily a cure ...

that's why it's called a "kill or cure". Take your pick.