As Weight Loss Surgery Skyrockets, Deaths and Risks Rise, Too

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As Weight Loss Surgery Skyrockets, Deaths and Risks Rise, Too http://www.bloomberg.com/apps/news?pid=10000082 & sid=aM8leMEtgjlo & refer=canada Oct. 18 (Bloomberg) -- The surge in weight loss surgery in the U.S. may be putting obese people at higher risk for illness and death than is generally known, three studies report. More than 100,000 Americans underwent bariatric surgery to reduce weight in 2003, an eight-fold increase in five years, researchers report in the Oct. 19 Journal of the American Medical Association. A separate analysis of Medicare patients published in the same issue found that 4.6 percent of patients undergoing the procedure died nationwide a year after surgery. The researchers said the findings may help obese people gauge the risks of the surgery as compared to health problems caused by being overweight. The operations can help patients shed more than half their unwanted weight and can reverse diabetes, high blood pressure and sleep problems, researchers said. ``This is not a vanity operation, it's a high-risk operation,'' said David R. Flum, associate professor of surgery and public health at the University of Washington in Seattle. ``This at least allows people who are considering this surgery to go in a little bit more with their eyes open.'' Medicare, the government's health insurance program for the elderly and disabled, is considering whether and when to pay for the weight-loss surgery. Reimbursement decisions are currently made by regions that control Medicare coverage policies. About one in five surgeries in Washington are performed on Medicare members, while almost none are covered by Medicare in other regions, researchers said. Small Stomach Pouch Researchers said they expect 130,000 bariatric surgeries to be performed in the U.S. this year. The procedure is considered the only proven method to reduce extreme weight, the researchers said. Gastric bypass was the most common procedure used in the studies. Surgeons make a small stomach pouch to restrict the amount of food that can be eaten and connect it to the lower part of the small intestine to limit digestion and absorption of calories. The operation can reduce weight in some cases by almost 100 pounds. Medicare patients may be most vulnerable to the risks of the surgery. Death rates were highest for men older than 65, with more than one in 10 dying within a year of surgery. Dying within a month was twice as likely after obesity surgery than with heart surgery or hip replacement, found the study of all 16,155 Medicare beneficiaries who had the operation from 1997 to 2002. ``That is significantly higher than most people expect when they think of obesity surgery,'' Flum said. ``Patients are at higher risk for having bad things happen after surgery because of their advanced age or other conditions.'' Experience Helps Death rates plunged even among the highest risk patients in the hands of experienced surgeons, the study found. ``If we're going to do this operation at all in patients 65 and older, it should really be done in places that can deliver the lowest risks to the patient,'' Flum said. All patients should expect hospitalizations after surgery, another study from the University of California at Los Angeles found. The number of hospital stays more than doubled in the year after surgery compared with the year earlier, scuttling hopes that better health after the operation would lessen health care needs, researchers said. Almost 8 percent of patients were hospitalized, mostly for obesity-related problems like arthritis, in the year before surgery, a review of all 60,000 patients getting the operation from 1995 to 2004 in California found. In the following 12 months, almost 20 percent were hospitalized, often for surgical complications. Pounds at a Price ``With the number of surgeries increasing and the number of patients considering surgery, they should be truly informed about what they are undergoing,'' said lead researcher David S. Zingmond, assistant professor of medicine at the UCLA's School of Medicine. While many patients lose 60 to 100 pounds, ``those pounds come at a price for some people,'' he said. The rate declined to 14.9 percent three years after surgery, with most hospitalizations triggered by the need for plastic surgery to remove excess skin or elective procedures such as back and knee surgery that were postponed because of the excess weight. The researchers originally anticipated that use of health care services would decline following surgery. Now, they say insurance companies and patients should be aware that hospitalization rates may be elevated for up to five years. Vulnerable Patients None of the studies examined the effectiveness of surgery, which the researchers agreed is the best weight loss method for obese people. Even with rising surgery rates, less than 1 percent of people who qualify undergo it, wrote surgeons Bruce M. Wolfe, from Oregon Health Science University in Portland and John M. Morton, of Stanford University in California, in an editorial. ``There are vulnerable patient populations and potential additional costs associated with surgery,'' they wrote. ``Bariatric surgery may be a potentially life-saving intervention in the right patients and in the right surgeons' hands.'' Michelle Fay Cortez in Minneapolis at mcortezLast Updated: October 18, 2005 16:01 EDT