July 30, 2009

Low Death Rates For Popular Obesity Surgeries

New research shows that the risks from obesity-related surgeries has dropped dramatically, and is now no riskier than having a gall bladder out, a hip replaced or most other major operations, The Associated Press reported.

Safety results for gastric bands and stomach stapling at 10 U.S. hospitals specializing in these procedures from 2005 through 2007 showed that for every 1,000 patients, three died during or within a month of their surgery, and only 43 had any major complication.

But only a few years earlier, similar studies cited 20 or so deaths per every 1,000 patients.

As for obesity and obesity surgeries, many studies have compared the risk factors between the two, and Dr. Eric DeMaria, weight loss surgery chief at Duke University Medical Center, said all show a higher risk of dying if you do not have surgical treatment than if you do.

The new study, lead by Dr. David Flum at the University of Washington in Seattle, appears in Thursday's New England Journal of Medicine.

The study stated that about one-third of American adults are obese, with a body mass index of 30 or more. The index is based on height and weight. For instance, someone who is 5-feet-4 is obese at 175 pounds; a 6-foot person is obese at 222 pounds.

However, obesity surgery is not advised unless someone has tried conventional ways to shed pounds and has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure, according to federal guidelines.

The American Society for Metabolic & Bariatric Surgery showed that at least 220,000 obesity surgeries were done in the United States in 2008.

Gastric bypass was the most popular method, in which a small pouch is stapled off from the rest of the stomach and connected to the small intestine. Those who undergo the surgery, which can be done with traditional surgery or laparoscopically, eat less because the pouch holds little food, and they absorb fewer calories.

Others may undergo a gastric band, in which a ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

The study looked at 3,412 gastric bypass patients and 1,198 given stomach bands in order to determine the safety of these methods.

Only 1 percent of people receiving bands, nearly 5 percent having laparoscopic gastric bypass, and nearly 8 percent of those given a traditional surgical bypass experienced death, serious complications or the need for another procedure.

The study found that complication rates were greater in people with a history of clot problems, sleep apnea and certain other medical issues.

Dr. Malcolm K. Robinson, a surgeon at Harvard Medical School, wrote in an editorial accompanying the study that the results put the spotlight on cost issues.

"In the past, now outdated bariatric procedures carried unacceptably high risks. The weight loss associated with the procedures was questionable, and the long-term health benefits were unproven," he wrote.

Robinson believes the evidence now shows that "surgery is safe, effective, and affordable," because it can lower doctor visits, medication use and other medical expenses.

"However, the expense of operating on the millions of potentially eligible obese adults could overwhelm an already financially stressed health care system," he concluded.

The study was financed and supported by the federal government. Many of the researchers involved have ties to companies that make obesity treatments, and several have testified in surgery lawsuits.


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