Worried About/Considering Surgery? Read this study.

ardbeg
on 7/17/07 10:11 am - AL

From another board, I found this study (PDF link) showing that you are more than 10 times more likely to die within the next five years if you don't have surgery than if you do.On a five year average of patients 1-16 years out from surgery compared to similarly aged and (starting) weighted non-ops, the death rates were 6.7% for non-ops compared to 0.68% for WLS patients A few more thoughts: The average patient was 45 years old, 2/3 female. I find it devastating that 6.7% of morbidly obese people with an average age of 45 were dead 5 years later. Obviously those were mostly older than 45, but still. It's not like a lot of them were 70+ either, since they were age matched to the patients with a 0.68% death rate. Really puts the risks of surgery versus the risks of trying to survive as a fat person for 5 more years (much less 40 more) in perspective. The 0.68% figure includes a 0.4% surgery death rate. So of those that survived surgery complications, only 0.28% died. I would have like to have seen age-matched actuarial data from the general population. Is 0.68% higher or lower than the general population at those ages? (Almost certainly higher.) How about 0.28%? Table 4, which shows morbidities for both groups, is incredible. Non-ops were 4 times more likely to get cancer. Really? Patients lost an average of 67.1% of excess weight. Excess weight was based on ideal BMI of 23.5. The average patient lost almost 80% of excess weight in the first two years. That number was still nearly 70% at 16 years. Plainly, rapid weight loss is not nearly as dangerous as your neighbor's-friend's-husband-who-is-a-doctor would have you believe. The average BMI changed from 50 to 32.6. A big decrease, but still technically obese. The standard deviation was 7.3, which means 16.5% of patients ended up with a BMI under 25.3, and 16.5% ended up with a BMI over 39.9. I find it notable that even though 16.5% stayed very obese, they still have a lower mortality rate than the average obese non-op. (Even if we assume this group accounts for all 0.28% of the non-surgery-complication deaths, that would mean 1.7% death rate for those with a 40+ post-op BMI, compared to 6.7% for the non-ops.) I would like to have seen the data broken down by gender. About a fifth of the patients studied were VGB, the rest RNY. Of the VGBs, 35% ended up having RNY subsequently. RNY patients lost 11% more weight than the VGB-only patients. Here's a link to short criticism of the methodology. The author has some valid points. I would add it's also hard to control for the factors that influenced the self-selection of those that got WLS. For example, it's possible that those that tend to seek WLS tend to be more compliant in taking prescribed medications, more knowledgeable of early warning signs of severe disease, more willing to seek early treatment in the face of warning signs, and/or more willing to make major behavior modifications if faced with a severe occurrence like a first heart attack or stroke. Such people would be less likely to die even if they hadn't had surgery. That said, the gap is so large that one has to believe that even if all of this was controlled for, surgery would still show a large benefit. If your family is nervous about you having surgery, show them this study. I hear a lot of guys say something like, "I have small children, and I'm worried about surgery and the risk of them losing me while they are still young." This study pretty conclusively shows that the risk of you not being there five years from now is much greater if you don't lose the weight.