One Wee****il My Surgery & Having Doubts...
Those of you who have been following my story know that I fought very hard to have my Lap Band taken out and now to finally have my revision to RNY. I am really having doubts tonight that I am doing the right thing... I had breathing problems from the anesthesia after my band removal and I am really worried that the same or worse will happen this time... I don't want to end up on a respirator or with other complications. I am really starting to second guess myself. October 4th will be my 60th birthday. Am I too old to start over again with a new WLS?
I guess I just need someone to tell me that I am not making the biggest mistake of my life...
Thanks,
Marcia
I guess I just need someone to tell me that I am not making the biggest mistake of my life...
Thanks,
Marcia
Marcia,
I think second guessing is very normal. Just make sure your doctor knows about the breathing problem. As long as you follow the rules you will be fine. I was 55 when I had my surgery...I won't lie...recovery was a *****but, it is so worth it. I'm here for ya!
Rosemary
277/150/147....and holding!
I think second guessing is very normal. Just make sure your doctor knows about the breathing problem. As long as you follow the rules you will be fine. I was 55 when I had my surgery...I won't lie...recovery was a *****but, it is so worth it. I'm here for ya!
Rosemary
277/150/147....and holding!
Marcia:
I believe YOU are the only one who can tell yourself this is the right thing to do....
To assist in finding inner peace with your decision to have WLS consider YOUR CHOICE reflects the responsible, powerful masterful spirit that you are and you're ready to start creating miracles in your life. Taking some time to meditate, journal, pray, use positive affirmations http://www.dailyinspiringquotes.com or http://www.nawls.com/public/department27.cfm or here http://www.unityonline.org/pray_prayersaffirmations.htm etc on your decision. Writing all the reasons why this is your choice, what your expectations and goals are (*consider those beyond wt loss itself), what you are fearful of.
ONLY you know if this is the right thing at the right time for you, anxiety/fear is common and normal, consider embracing the feelings, they are only that feelings they have a beginning/middle/end and serve us well if we listen vs avoid/repress/stuff them. See this opportunity as one where you can grow. I was motivated but scared as well of dying..a hard decision but one I do not regret making....
I recommend you consider trying to fill your mind with as much optimism and positive thinking as possible! Basically, become more conscious of what you are thinking and feeling, and start preparing yourself to think of food and your life in a different way. This is a courageous step for you to take, and it's not just about weight changing -- it's about life changing. This is why so many of us are challenged by the enormity of the decision.
Maybe use positive thinking such as:
"I AM COMMITTED TO FACE AND RESOLVE THE PROBLEMS OF LIVING" (i.e. no longer be morbidly obese)
"MY SUCCESS DEPENDS UPON MY CHOICES AND MY BEHAVIOR IN THE PRESENT" (i.e. having the surgery, committing to a healthy lifestyle)
"ALTHOUGH I MAY NOT HAVE TOTAL CONTROL OVER WHAT HAPPENS IN MY LIFE, I CAN ALWAYS CONTROL MYSELF AND HOW I RESPOND TO WHAT HAPPENS" (i.e. complications but how I manage them if they happen is up to me).
THIS EMPOWERS YOU NO MATTER WHAT LIFE BRINGS!!!
YES THIS IS NOT THE EASY WAY OUT! It takes extraordinary courage to make the decision and live w/ the choices we make to consciously limit food choices for the rest of our lives (and potentially limit social opportunities built around meals) among all the other potential complications it can bring short or long-term....
There will be plenty of opportunities to grow/change in life as it can be one stressor/problem after another but deciding to keep on keeping on will always help! Hugs!
I will keep you in my thoughts and prayers! You are a warrior and worthy of this opportunity to change your life...Be well.
The Serenity Prayer always helps me in times such as this *I am hoping this will not be offensive...
"God grant us the serenity to accept the things we cannot change, courage to change the things we can, and wisdom to know the difference."
We had a woman 73 in our support group who had WLS 3 yrs ago and has no regrets....
~~~~~~~~~~~~~
Weight Loss Surgery Safe for Seniors Older Patients Can Benefit From
Gastric Bypass Surgery, Researchers Say
By Miranda Hitti
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Tuesday, February 22, 2005
http://www.webmd.com/news/20050222/weight-loss-surgery-safe-for-seniors
Feb. 22, 2005 -- Gastric bypass surgery isn't just for the young, says a
study in February's /Archives of Surgery/.
The weight loss procedure has soared in popularity. Gastric bypass was
performed 10 times as often in 2001 as in 1987.
In the procedure, surgeons bypass the stomach by closing off a section
of the stomach, leaving a small pouch that accommodates a few ounces of
food. That drastically reduces the amount of food that people can eat.
The pouch is attached to part of the small intestine so that food
bypasses the rest of the stomach to reduce absorption of calories and
nutrients.
*Obesity Boom Drives Demand*
Interest in gastric bypass has grown along with America's waistline.
Nearly 20% of the U.S. population was obese in 2001, compared to 12% 10
years earlier, say James Swain, MD, and colleagues from the Mayo Clinic
in Scottsdale, Ariz.
Dramatic weight loss stories from celebrities and other obese people
who've undergone the surgery have also fueled interest. Less invasive
procedures have also become available that avoid the large incision
normally made during the bypass procedure and cut down on in-hospital
recovery time.
But some headlines have noted the dangers that can occur. Last October,
two studies showed that the short-term dangers may be higher than
previously thought, although the long-term benefits of shedding extra
pounds could make the surgery worthwhile.
Does Age Make a Difference in Gastric Bypass Surgery?
*Does Age Make a Difference in Gastric Bypass Surgery?*
The risks apply to everyone. Weight loss surgery isn't done casually;
it's a last resort for overweight or obese individuals who have tried
other methods and have been unsuccessful. But age alone doesn't rule out
the procedure, say James Swain, MD, and colleagues from the Mayo Clinic
in Scottsdale, Ariz.
Provided that older patients are healthy enough to have the surgery,
"patients of advanced age can safely undergo [gastric bypass]," write
the researchers.
That goes against some providers' policies, they say. Since so many
people are obese and Americans are living longer than ever before,
Swain's team took a fresh look at gastric bypass surgery and age.
*Gauging Health Before Surgery*
Study participants were 110 people younger than 60 years old and 20
people who were older than 60 years old. All were morbidly obese and had
other medical conditions related to obesity.
The younger patients were about 45 years old on average. The older
patients had an average age of 65.
Before surgery, both groups weighed a little over 300 pounds (305 pounds
for the older group and 301 pounds for the younger group). The younger
group's body mass index (BMI) was higher (48, compared with 42 for the
older group).
Which Age Group Fared Better?
*Which Age Group Fared Better?*
Judging by the scale, the younger patients did a bit better. They lost
more weight and had a greater drop in BMI.
The younger patients lost nearly 97 pounds, lowering their BMI by 15
points. The older patients shed about 86 pounds and dropped almost 13
BMI points.
The younger patients also unloaded an average of 2.3 obesity-related
medical problems such as sleep apnea. While the older patients also
improved their health, they dropped just under two health problems after
the weight loss surgery.
But the older patients fared better in another area. After the surgery,
they were able to reduce the number of medications they normally took.
At the last follow-up, they took an average of 2.7 medications, down
from nearly five. The younger patients also cut back to barely one
prescription per person after surgery. That's a significant decrease,
but it's less than what their elders achieved.
Both groups had similar rates of complications and stayed in the
hospital for roughly the same number of days (about three days for the
older patients and 2.5 days for the younger ones).
"Patients older than 60 years can be considered good candidates for
obesity surgery," say the researchers. They plan longer follow-up to
track survival and health cost savings.
------------------------------------------------------------------------
SOURCES: St. Peter, S. /Archives of Surgery/, February 2005; vol 140: pp
165-168. WebMD Medical News: "Studies Weigh Risks of Gastric Bypass
Surgery." WebMD Medical Reference from Healthwise: "Gastric Bypass
Surgery Overview." News release, JAMA/Archives.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
http://www.medscape.com/viewarticle/507706
Gastric Bypass is Safe and Effective for Morbidly Obese Elderly
Yael Waknine;
Medscape Medical News 2005. © 2005 Medscape
July 1, 2005 -- Gastric bypass surgery is safe and resolves or significantly improves comorbid conditions of morbid obesity in the elderly, according to the results of a retrospective study presented at the 22nd Annual Meeting of the American Society for Bariatric Surgery in Orlando, Florida.
Patients in this population demonstrate an extremely high level of postoperative compliance.
"Life expectancy at [age] 65 [years] is increasing, and cardiac surgery, neurosurgery, and other aggressive treatments have been offered to elderly patients to improve their quality and quantity of life -- why not weight loss surgery?," Ricardo Cohen, MD, lead investigator, told Medscape.
Dr. Cohen is director of the Center for the Surgical Treatment of Morbid Obesity at São Camilo Hospital in São Paulo, Brazil.
According to Dr. Cohen, morbidly obese elderly patients who opt for the procedure do so with the intent of resolving life-threatening comorbidities rather than for cosmetic reasons.
"Elderly patients are more mature than young adults -- they understand the surgery, are serious about improving their quality and quantity of life, and are extremely adherent to treatment," Dr. Cohen noted.
In the study, investigators evaluated the effects of laparoscopic Roux-en-Y gastric bypass surgery in 108 patients aged 60 years and older (mean age, 66 years; range, 60 - 76 years; two thirds women) with a mean body mass index (BMI) of 44 kg/m2 (range, 38 - 55 kg/m2). Preoperative comorbidities included arthropathy (n = 76), hypertension (HTN; n = 73), diabetes (n = 66), cardiopathy (n = 54), lipid disorders (n = 35), gastroesophageal reflux disease (GERD; n = 19), and sleep apnea (n = 12).
No intraoperative complications occurred and mean hospital stay was 36 hours; no postoperative leaks developed. "If you do a complete preoperative workup and consult with specialists regarding the comorbid conditions, the surgical risks are the same as for younger patients," Dr. Cohen noted.
Postoperative compliance was extremely high; 92.6% of patients continued to follow up regularly with their physician for 48 months compared with 68.8% of younger patients. In addition, 81% of elderly patients continued to exercise regularly.
Excess weight loss was 71% at 12 months, 69% at 24 months, and 67% at 48 months, relative to baseline. "Elderly patients lose about 10% less weight than young adults after gastric bypass, but show more gains in quality of life by curing or significantly improving their comorbidities."
At 48 months, 63%, 77%, and 94% of patients achieved resolution of HTN, diabetes, and lipid disorders, respectively. In addition, 32% of HTN patients presented with more easily controlled disease, 9% of diabetic patients required less medication, and 100% of patients with cardiopathy showed significant improvement in their disease. GERD and sleep apnea were resolved in all patients.
"Elderly patients with morbid obesity are not interested in looking good in bathing suits -- they want to stop taking 10 pills a day for comorbid conditions," Dr. Cohen concluded. "They are serious about following instructions and adhering to treatment, and there is no doubt that gastric bypass surgery greatly improves their quality of life."
The investigators report no pertinent financial disclosures.
22nd Annual Meeting ASBS: Oral Presentation. Presented July 1, 2005.
Reviewed by Gary D. Vogin, MD
~~~~~~~~~~
now THIS SAYS HIGHER RISKS BUT AGE 65 IS THE ISSUE YOU ARE UNDER THAT!!!!!!!!
http://www.medscape.com/viewarticle/548701
--------------------------------------------------------------------------------
Risk of Poor Outcomes From Bariatric Surgery May Be Greater in Elderly
Laurie Barclay, MD
Medscape Medical News 2006. © 2006 Medscape
December 1, 2006 -- The rate of adverse events and mortality after bariatric surgery is higher in elderly patients, with male sex and electrolyte disorders as independent risk factors, according to the results of a study reported in the December issue of the Archives of Surgery.
"Medicare assembled a medical care advisory committee to review the available literature supporting application of bariatric surgery to the Medicare population," write Edward H. Livingston, MD, and Joshua Langert, BA, from the Veterans Affairs North Texas Health Care System and Southwestern Medical School, University of Texas (UT) Southwestern Medical Center, Dallas. "The committee concluded that there were insufficient data to arrive at recommendations relevant to the Medicare patients. The major issues needing clarification are the perioperative safety for weight loss operations and long-term weight loss and comorbidity control for older and other Medicare-eligible patients."
Using a national sample of hospitalized patients in the United States, the investigators identified 25,428 bariatric procedures performed in adult patients in 2001 and 2002.
Logistic regression revealed that independent risk factors for bariatric surgery mortality were age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 - 1.07), male sex (OR, 2.45; 95% CI, 1.48 - 4.03), electrolyte disorders (OR, 13.91; 95% CI, 8.29 - 23.33), and congestive heart failure (OR, 4.96; 95% CI, 2.52 - 9.77).
Adverse outcomes increased nearly linearly as a function of age, with a sharp increase after age 65 years. For patients aged 65 years and older, adverse event rates exceeded 20%, and in-house mortality was 3.2%. Most Medicare patients who had bariatric surgery were younger than 65 years and had a much greater disease burden than did non-Medicare patients.
"Age, male sex, electrolyte disorders, and congestive heart failure were independent risk factors for bariatric surgical mortality," the authors write. "Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients."
Study limitations include accepting older patients for surgery only if they were optimal candidates, imprecise disease and procedure coding, and lack of detailed patient-specific information.
The authors report no relevant financial relationships. The UT Southwestern Medical Center Medical Student Research Program supported this study.
In an accompanying critique, Clifford W. Deveney, MD, from Oregon Health & Science University in Portland, notes additional limitations inherent in retrospective data acquisition from large databases.
"While the study is quite helpful in assessing operative risk stratification, it does not provide any long-term follow-up to assess benefits or to determine how much risk is appropriate," Dr. Deveney writes. "We need to look at benefits in the vast majority of patients who survive their bariatric procedure to determine what is an appropriate risk for a given patient. These data will only come from prospective studies designed to assess long-term outcomes following bariatric procedures."
Dr. Deveney reports no relevant financial relationships.
Arch Surg. 2006;141:1115-1120.
I believe YOU are the only one who can tell yourself this is the right thing to do....
To assist in finding inner peace with your decision to have WLS consider YOUR CHOICE reflects the responsible, powerful masterful spirit that you are and you're ready to start creating miracles in your life. Taking some time to meditate, journal, pray, use positive affirmations http://www.dailyinspiringquotes.com or http://www.nawls.com/public/department27.cfm or here http://www.unityonline.org/pray_prayersaffirmations.htm etc on your decision. Writing all the reasons why this is your choice, what your expectations and goals are (*consider those beyond wt loss itself), what you are fearful of.
ONLY you know if this is the right thing at the right time for you, anxiety/fear is common and normal, consider embracing the feelings, they are only that feelings they have a beginning/middle/end and serve us well if we listen vs avoid/repress/stuff them. See this opportunity as one where you can grow. I was motivated but scared as well of dying..a hard decision but one I do not regret making....
I recommend you consider trying to fill your mind with as much optimism and positive thinking as possible! Basically, become more conscious of what you are thinking and feeling, and start preparing yourself to think of food and your life in a different way. This is a courageous step for you to take, and it's not just about weight changing -- it's about life changing. This is why so many of us are challenged by the enormity of the decision.
Maybe use positive thinking such as:
"I AM COMMITTED TO FACE AND RESOLVE THE PROBLEMS OF LIVING" (i.e. no longer be morbidly obese)
"MY SUCCESS DEPENDS UPON MY CHOICES AND MY BEHAVIOR IN THE PRESENT" (i.e. having the surgery, committing to a healthy lifestyle)
"ALTHOUGH I MAY NOT HAVE TOTAL CONTROL OVER WHAT HAPPENS IN MY LIFE, I CAN ALWAYS CONTROL MYSELF AND HOW I RESPOND TO WHAT HAPPENS" (i.e. complications but how I manage them if they happen is up to me).
THIS EMPOWERS YOU NO MATTER WHAT LIFE BRINGS!!!
YES THIS IS NOT THE EASY WAY OUT! It takes extraordinary courage to make the decision and live w/ the choices we make to consciously limit food choices for the rest of our lives (and potentially limit social opportunities built around meals) among all the other potential complications it can bring short or long-term....
There will be plenty of opportunities to grow/change in life as it can be one stressor/problem after another but deciding to keep on keeping on will always help! Hugs!
I will keep you in my thoughts and prayers! You are a warrior and worthy of this opportunity to change your life...Be well.
The Serenity Prayer always helps me in times such as this *I am hoping this will not be offensive...
"God grant us the serenity to accept the things we cannot change, courage to change the things we can, and wisdom to know the difference."
We had a woman 73 in our support group who had WLS 3 yrs ago and has no regrets....
~~~~~~~~~~~~~
Weight Loss Surgery Safe for Seniors Older Patients Can Benefit From
Gastric Bypass Surgery, Researchers Say
By Miranda Hitti
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Tuesday, February 22, 2005
http://www.webmd.com/news/20050222/weight-loss-surgery-safe-for-seniors
Feb. 22, 2005 -- Gastric bypass surgery isn't just for the young, says a
study in February's /Archives of Surgery/.
The weight loss procedure has soared in popularity. Gastric bypass was
performed 10 times as often in 2001 as in 1987.
In the procedure, surgeons bypass the stomach by closing off a section
of the stomach, leaving a small pouch that accommodates a few ounces of
food. That drastically reduces the amount of food that people can eat.
The pouch is attached to part of the small intestine so that food
bypasses the rest of the stomach to reduce absorption of calories and
nutrients.
*Obesity Boom Drives Demand*
Interest in gastric bypass has grown along with America's waistline.
Nearly 20% of the U.S. population was obese in 2001, compared to 12% 10
years earlier, say James Swain, MD, and colleagues from the Mayo Clinic
in Scottsdale, Ariz.
Dramatic weight loss stories from celebrities and other obese people
who've undergone the surgery have also fueled interest. Less invasive
procedures have also become available that avoid the large incision
normally made during the bypass procedure and cut down on in-hospital
recovery time.
But some headlines have noted the dangers that can occur. Last October,
two studies showed that the short-term dangers may be higher than
previously thought, although the long-term benefits of shedding extra
pounds could make the surgery worthwhile.
Does Age Make a Difference in Gastric Bypass Surgery?
*Does Age Make a Difference in Gastric Bypass Surgery?*
The risks apply to everyone. Weight loss surgery isn't done casually;
it's a last resort for overweight or obese individuals who have tried
other methods and have been unsuccessful. But age alone doesn't rule out
the procedure, say James Swain, MD, and colleagues from the Mayo Clinic
in Scottsdale, Ariz.
Provided that older patients are healthy enough to have the surgery,
"patients of advanced age can safely undergo [gastric bypass]," write
the researchers.
That goes against some providers' policies, they say. Since so many
people are obese and Americans are living longer than ever before,
Swain's team took a fresh look at gastric bypass surgery and age.
*Gauging Health Before Surgery*
Study participants were 110 people younger than 60 years old and 20
people who were older than 60 years old. All were morbidly obese and had
other medical conditions related to obesity.
The younger patients were about 45 years old on average. The older
patients had an average age of 65.
Before surgery, both groups weighed a little over 300 pounds (305 pounds
for the older group and 301 pounds for the younger group). The younger
group's body mass index (BMI) was higher (48, compared with 42 for the
older group).
Which Age Group Fared Better?
*Which Age Group Fared Better?*
Judging by the scale, the younger patients did a bit better. They lost
more weight and had a greater drop in BMI.
The younger patients lost nearly 97 pounds, lowering their BMI by 15
points. The older patients shed about 86 pounds and dropped almost 13
BMI points.
The younger patients also unloaded an average of 2.3 obesity-related
medical problems such as sleep apnea. While the older patients also
improved their health, they dropped just under two health problems after
the weight loss surgery.
But the older patients fared better in another area. After the surgery,
they were able to reduce the number of medications they normally took.
At the last follow-up, they took an average of 2.7 medications, down
from nearly five. The younger patients also cut back to barely one
prescription per person after surgery. That's a significant decrease,
but it's less than what their elders achieved.
Both groups had similar rates of complications and stayed in the
hospital for roughly the same number of days (about three days for the
older patients and 2.5 days for the younger ones).
"Patients older than 60 years can be considered good candidates for
obesity surgery," say the researchers. They plan longer follow-up to
track survival and health cost savings.
------------------------------------------------------------------------
SOURCES: St. Peter, S. /Archives of Surgery/, February 2005; vol 140: pp
165-168. WebMD Medical News: "Studies Weigh Risks of Gastric Bypass
Surgery." WebMD Medical Reference from Healthwise: "Gastric Bypass
Surgery Overview." News release, JAMA/Archives.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
http://www.medscape.com/viewarticle/507706
Gastric Bypass is Safe and Effective for Morbidly Obese Elderly
Yael Waknine;
Medscape Medical News 2005. © 2005 Medscape
July 1, 2005 -- Gastric bypass surgery is safe and resolves or significantly improves comorbid conditions of morbid obesity in the elderly, according to the results of a retrospective study presented at the 22nd Annual Meeting of the American Society for Bariatric Surgery in Orlando, Florida.
Patients in this population demonstrate an extremely high level of postoperative compliance.
"Life expectancy at [age] 65 [years] is increasing, and cardiac surgery, neurosurgery, and other aggressive treatments have been offered to elderly patients to improve their quality and quantity of life -- why not weight loss surgery?," Ricardo Cohen, MD, lead investigator, told Medscape.
Dr. Cohen is director of the Center for the Surgical Treatment of Morbid Obesity at São Camilo Hospital in São Paulo, Brazil.
According to Dr. Cohen, morbidly obese elderly patients who opt for the procedure do so with the intent of resolving life-threatening comorbidities rather than for cosmetic reasons.
"Elderly patients are more mature than young adults -- they understand the surgery, are serious about improving their quality and quantity of life, and are extremely adherent to treatment," Dr. Cohen noted.
In the study, investigators evaluated the effects of laparoscopic Roux-en-Y gastric bypass surgery in 108 patients aged 60 years and older (mean age, 66 years; range, 60 - 76 years; two thirds women) with a mean body mass index (BMI) of 44 kg/m2 (range, 38 - 55 kg/m2). Preoperative comorbidities included arthropathy (n = 76), hypertension (HTN; n = 73), diabetes (n = 66), cardiopathy (n = 54), lipid disorders (n = 35), gastroesophageal reflux disease (GERD; n = 19), and sleep apnea (n = 12).
No intraoperative complications occurred and mean hospital stay was 36 hours; no postoperative leaks developed. "If you do a complete preoperative workup and consult with specialists regarding the comorbid conditions, the surgical risks are the same as for younger patients," Dr. Cohen noted.
Postoperative compliance was extremely high; 92.6% of patients continued to follow up regularly with their physician for 48 months compared with 68.8% of younger patients. In addition, 81% of elderly patients continued to exercise regularly.
Excess weight loss was 71% at 12 months, 69% at 24 months, and 67% at 48 months, relative to baseline. "Elderly patients lose about 10% less weight than young adults after gastric bypass, but show more gains in quality of life by curing or significantly improving their comorbidities."
At 48 months, 63%, 77%, and 94% of patients achieved resolution of HTN, diabetes, and lipid disorders, respectively. In addition, 32% of HTN patients presented with more easily controlled disease, 9% of diabetic patients required less medication, and 100% of patients with cardiopathy showed significant improvement in their disease. GERD and sleep apnea were resolved in all patients.
"Elderly patients with morbid obesity are not interested in looking good in bathing suits -- they want to stop taking 10 pills a day for comorbid conditions," Dr. Cohen concluded. "They are serious about following instructions and adhering to treatment, and there is no doubt that gastric bypass surgery greatly improves their quality of life."
The investigators report no pertinent financial disclosures.
22nd Annual Meeting ASBS: Oral Presentation. Presented July 1, 2005.
Reviewed by Gary D. Vogin, MD
~~~~~~~~~~
now THIS SAYS HIGHER RISKS BUT AGE 65 IS THE ISSUE YOU ARE UNDER THAT!!!!!!!!
http://www.medscape.com/viewarticle/548701
--------------------------------------------------------------------------------
Risk of Poor Outcomes From Bariatric Surgery May Be Greater in Elderly
Laurie Barclay, MD
Medscape Medical News 2006. © 2006 Medscape
December 1, 2006 -- The rate of adverse events and mortality after bariatric surgery is higher in elderly patients, with male sex and electrolyte disorders as independent risk factors, according to the results of a study reported in the December issue of the Archives of Surgery.
"Medicare assembled a medical care advisory committee to review the available literature supporting application of bariatric surgery to the Medicare population," write Edward H. Livingston, MD, and Joshua Langert, BA, from the Veterans Affairs North Texas Health Care System and Southwestern Medical School, University of Texas (UT) Southwestern Medical Center, Dallas. "The committee concluded that there were insufficient data to arrive at recommendations relevant to the Medicare patients. The major issues needing clarification are the perioperative safety for weight loss operations and long-term weight loss and comorbidity control for older and other Medicare-eligible patients."
Using a national sample of hospitalized patients in the United States, the investigators identified 25,428 bariatric procedures performed in adult patients in 2001 and 2002.
Logistic regression revealed that independent risk factors for bariatric surgery mortality were age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 - 1.07), male sex (OR, 2.45; 95% CI, 1.48 - 4.03), electrolyte disorders (OR, 13.91; 95% CI, 8.29 - 23.33), and congestive heart failure (OR, 4.96; 95% CI, 2.52 - 9.77).
Adverse outcomes increased nearly linearly as a function of age, with a sharp increase after age 65 years. For patients aged 65 years and older, adverse event rates exceeded 20%, and in-house mortality was 3.2%. Most Medicare patients who had bariatric surgery were younger than 65 years and had a much greater disease burden than did non-Medicare patients.
"Age, male sex, electrolyte disorders, and congestive heart failure were independent risk factors for bariatric surgical mortality," the authors write. "Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients."
Study limitations include accepting older patients for surgery only if they were optimal candidates, imprecise disease and procedure coding, and lack of detailed patient-specific information.
The authors report no relevant financial relationships. The UT Southwestern Medical Center Medical Student Research Program supported this study.
In an accompanying critique, Clifford W. Deveney, MD, from Oregon Health & Science University in Portland, notes additional limitations inherent in retrospective data acquisition from large databases.
"While the study is quite helpful in assessing operative risk stratification, it does not provide any long-term follow-up to assess benefits or to determine how much risk is appropriate," Dr. Deveney writes. "We need to look at benefits in the vast majority of patients who survive their bariatric procedure to determine what is an appropriate risk for a given patient. These data will only come from prospective studies designed to assess long-term outcomes following bariatric procedures."
Dr. Deveney reports no relevant financial relationships.
Arch Surg. 2006;141:1115-1120.
Take Care, 
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Hi Marcia - I am late in reading OH this week but saw your post and had to tell you that you may have doubts that is so common - I had them right up until I went into the OR! Since you have had surgery before, you know the risks involved and as others have said just let your surgeon/staff be aware of it. I was so heavy I feared they'd never be able to do me at all and I am 1 month out and doing fine. - You will too. We are all here for you and I see alot of people have given you very good advice - we all care for and about each other - I will keep you in my thoughts and prayers - take good care and hang in there!! It will get better - you have already been through alot- Mary (Molly P)
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