South Florida Sun-Sentinel, 10-19-05
FORT LAUDERDALE, Fla. - Bariatric surgical procedures, such as gastric bypass surgery, to achieve sustained weight loss have increased dramatically in the past five years, but research published Wednesday shows a higher risk of death in the months afterward than was previously known.
Writing in the Journal of the American Medical Association, researchers said the overall death rate during the first year after such stomach surgeries is as high as 7.5 percent, and men, older patients and patients of surgeons less experienced in doing the surgeries are most at risk.
The data were from a review of more than 16,000 patients who were covered by Medicare, with an average age of 48. Medicare is the federal insurance program covering disabled people as well as those 65 and over.
Dr. Patricia Byers, director of bariatric surgery at the University of Miami Miller School of Medicine, said she hopes insurers will not use the information in the study as a reason not to cover the procedures.
"I'm just very concerned this data is going to be taken the wrong way," Byers said. "It's a very big operation on very sick people. It needs to be compared to other similar operations, such as a kidney transplant."
Morbid obesity has increased dramatically in the past decade. The number of people with a body mass index (BMI) of higher than 40, a ratio of height to weight, quadrupled from 1 in 200 to 1 in 50 between 1986 and 2000, while those with a BMI of 50 quintupled from one in 2,000 to one in 400.
Morbidly obese people who are considering having the surgery need to approach it with the right frame of mind and be cognizant of the risks and the benefits, Byers said, and should only have the surgery after attempts to lose weight by diet and exercise, and keep it off, have failed.
"A 40-year-old man with a BMI of 40, his life on average will be shortened by 16 years," if he doesn't lose the weight, Byer said.
Byers and Dr. Michel Murr, director of bariatric surgery at the University of South Florida and Tampa General Hospital, have done a study of 25 older patients who had the procedures at their hospitals and found a much lower complication rate than the JAMA study.
Murr will spend Wednesday in Tallahassee testifying before the Florida Senate Health Committee on the need for insurers to cover bariatric surgeries, but he said he understands insurers concerns about quality of the procedures.
"Not everybody (is allowed to do) liver transplants. We need to concentrate bariatric surgeries in certain centers where we can track the outcomes," Murr said.
Surgical procedures to induce weight loss have escalated from 13,365 in 1998, to an estimated 102,794 in 2003.
"If our observed rate of growth continues, there will be approximately 130,000 bariatric procedures in 2005, and as many as 218,000 in 2010," the authors said. "The cost to the U.S. health care system will be substantial.
In an editorial in the same issue, doctors said bariatric surgery is a potentially life-saving intervention in the right patients and in the right surgeons' hands, but the studies indicate that "experience and technique count." And despite the problems reported by researchers, "bariatric surgery today remains a fundamental therapy for morbidly obese patients."
Drs. Bruce Wolfe, of Oregon Health & Science University, and John Morton, of Stanford University, said the research should be seen as an opportunity for improvement in surgery techniques and not as an excuse by insurers to avoid covering the procedures for people who need them.