Death Rates From Bariatric Surgery

Two new studies add to the growing debate over the potential benefits and risks of using bariatric surgeries to treat obesity. Extremely obese people who have gastric-bypass surgery may live longer than other obese people who haven't had the procedure, the research suggests. But one in 50 gastric-bypass patients die within a month after the operation, which is higher than previously reported, one of the studies found. Supporters argue that the surgery, which creates a much smaller stomach and rearranges the small intestine, can save lives of severely obese people. Obesity is defined as being 100 or more pounds over a healthy body weight. Excess weight increases the risk of diabetes, heart disease, cancer and other illnesses. The surgery costs an average of $26,000. But critics say the risks of the surgery far outweigh the benefits, setting people up for malnutrition and other medical problems that can lead to higher costs. In one of the new studies, researchers with the University of Washington in Seattle evaluated the health records of 66,109 obese patients in the state; 3,328 had a gastric-bypass operation over a 15-year period. The other obese patients had been hospitalized for some other medical reason. The findings, published in October's Journal of the American College of Surgeons: *One in 50 surgery patients died within 30 days. (Other studies have reported one in 200 or one in 500 die.) *About 3% of gastric-bypass patients younger than 40 had died in the 13.6 years after the surgery, compared with 13.8% of those who did not have the surgery. *Overall, 11.8% of gastric-bypass patients of all ages had died after 15 years, compared with 16.3% who hadn't been operated on. "A limitation of the study is we don't know if the people who get the surgery are healthier or sicker than those who don't," says lead researcher David Flum, a gastrointestinal surgeon at University of Washington School of Medicine. There are risks of dying during or after gastric bypass, but those who make it often get improvements in diabetes, heart disease, lung function and other medical problems and seem to live longer, he says. Previous research that examined the risk of dying was from "the best surgeons in the country presenting their best results," Flum says. The new data included all levels of surgical experience. Patients are five times more likely to die if the surgeon has less experience, he says. In another study, researchers at McGill University Health Centre in Montreal compared 1,035 morbidly obese patients who had bariatric surgery, mostly gastric bypass, with 5,746 who were similarly overweight but did not have the operation. The findings in September's Annals of Surgery showed that gastric-bypass patients lost 67% of their excess weight. And in a five-year follow-up period, six people died who had the surgery (four because of the operation), compared with 350 who died in the larger group. After adjusting for the different size of the groups, researchers say bariatric patients had an 89% reduced risk of death. "If you take obese people and invest some money in this surgery, you are going to save lives," says lead researcher Nicolas Christou, who is head of general surgery at McGill. He performs many of the gastric-bypass surgeries in Canada. Paul Ernsberger, an opponent of bariatric surgery and an associate professor of nutrition at Case Western Reserve University School of Medicine in Cleveland, echoes Flum's concern that the patients who didn't have the surgery in these studies may have been sicker than those who did. The studies have limitations but are important, says Samuel Klein of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. "They suggest that bariatric surgery improves long-term survival in extremely obese patients, but there is an increased risk upfront." Copyright (c) 2004 Gannett/USA TODAY Electronic News