Recent studies suggest that stomach-shrinking surgery is more dangerous than had been thought especially for men, the elderly, and people with conditions such as hypertension.
A study of 16,155 Medicare patients by Dr. David Flum of the University of Washington, published in the Journal of the American Medical Association, also found less experienced surgeons are putting patients at risk.
According to Flum, while patients are told the mortality rate is approximately one in 500 (.2%) to one in 1,000 (.1%) it can be considerably higher for specific groups such as those over the age of 65 and those who are disabled by a range of problems including obesity where "the risk of death is more like one in 50" (2%).
Flum’s study found 11% of patients over 65 died after stomach-shrinking surgery, a mortality rate higher even than that following open-heart surgery.
Men were found to be twice as likely to die as women, with a mortality rate of 7.5 % within a year of their surgery. (Women make up about 80% of the patients undergoing the procedure).
The death rate after 30 days was 2% for Medicare recipients. After 90 days, that rate was 2.8% and after a year, 4.6%t. This study also found the death rate was 1.6 times higher when done by a surgeon who performed a low volume of bariatric surgeries.
"Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures," wrote the study authors.
In a related study, re-hospitalization rates within a year following the surgery were found to be as high as 19%, while another said bariatric surgery has increased substantially since 1998 when only 13,365 procedures were performed.
The latter estimated 130,000 procedures would be performed in the United States in 2005. The number is expected to rise to 218,000 by 2010. A large number of these patients are women, and nearly two-thirds live in neighborhoods with the highest household incomes.
The increase in procedures corresponds with the quadrupling of the obesity rate between 1986 and 2000. According to Heena Santry of the, University of Chicago, about 5% of U.S. adults are “morbidly obese” having a body mass index of 40 or higher.
The most commonly performed bariatric surgery is Roux-en-Y gastric-bypass where the stomach is made smaller and a part of the small intestine is bypassed so that fewer calories and nutrients are absorbed. Among the risks from this procedure are infection, hernia, and long-term nutritional deficiencies.
Dr. Edward Livingston, chairman of gastrointestinal and endocrine surgery at the University of Texas Southwestern School of Medicine and chairman of the bariatric surgery work group for the Department of Veteran’s Affairs national health care system said, "I was not surprised by these findings. These studies are really a very small piece of the overall picture for bariatric surgery."
According to Livingston; "Bariatric surgeries result in weight loss, but they can result in complications and death. They can improve the complications of obesity and quality of life, and they may increase longevity." He reminded patients, however, that the decision about whether to have the surgery is a complicated one, and needs to be made on a fully informed, case-by-case basis.
Clearly, the elevated risks of death and other serious complications of bariatric surgery in particular classes of people is a factor that should be explored and explained to prospective patients especially when they belong to one or more of those higher-risk groups.