Studies Examine Life After Weight-Loss Surgery

MONDAY Oct. 15, 2007 -- Coronary heart disease and suicide helped fuel the rise in the risk of death among patients after weight-loss surgery, a new study finds.

The research found that about one percent of people who had bariatric surgery in Pennsylvania between 1995 and 2004 died within a year of the surgery, and 6.4 percent died within five years.

Following 16,683 operations, 440 patients (2.6 percent) died, noted the University of Pittsburgh study. That's higher than the death rate for age- and sex-matched people in the general population.

The findings are published in the October issue of the journal Archives of Surgery, a themed issue on bariatric surgery.

The increased risk of death among bariatric surgery patients is "likely a function of the initial comorbidities related to substantial obesity and the likelihood that the patients remain obese even after the substantial weight loss and have remaining comorbidities," the study authors wrote.

Among their findings:

  • Less than one percent of deaths occurred within the first 30 days after surgery.
  • Death rates increased with age, especially among patients older than 65. The average age at time of surgery was 48 years.
  • Heart disease was the leading cause of death, killing 76 patients (19.2 percent). This is higher than the rate of heart disease death in the general population.
  • Of the 45 deaths from traumatic causes, 16 (4 percent of all deaths) were suicides, and 14 (3 percent) were drug overdoses not classified as suicide. In the general population, only two suicide deaths would have been expected among the same number of people.

"It is likely that this continued excess mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes mellitus, hyperlipidemia (high cholesterol) and smoking, as well as efforts to prevent weight regain by diet and exercise and psychological support to prevent and treat depression and suicide," the study authors concluded.

Another study in the same issue of the Archives of Surgery found that high-risk morbidly obese patients who lose 5 percent to 10 percent or more of their excess weight before gastric bypass surgery may have shorter hospital stays and lose weight more quickly after the surgery.

Researchers at Geisinger Health Care System in Danville, Pa., studied 884 patients, average age 45. Of those patients, 169 lost 5 percent to 10 percent of their excess weight before surgery, and 425 lost 10 percent or more of their excess weight beforehand.

Compared to patients who lost zero to 5 percent of excess weight before surgery, those who lost more than 5 percent were less likely to stay in hospital longer than four days, and those who lost more than 10 percent of excess weight were more than twice as likely to have lost 70 percent of their excess weight one year after their gastric bypass surgery.

Improvements in physical health associated with weight loss may help reduce surgical complications and shorten a patient's hospital stay, the study authors suggested. More research is needed to examine how pre-surgery weight loss may help with long-term weight loss after surgery.

One expert added a note of caution to the Pennsylvania results, however.

The findings "highlight that pre-operative weight loss leads to better short-term results," Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital, New York City, said in a statement issued Monday. "What can be my issue with this study? My fear and knowledge that these results will be used [by insurers] as an attempt to ration care for obesity and restrict access to weight loss surgery."

According to Roslin, even obese patients who do not lose weight before such surgeries "still have better results with surgery, than with any other treatment option. Since we do not ration care for any other disease, is it fair to ration for obesity? Our role should be to find the best treatment for each individual, not only offer surgery for those who do best."

A third study found that obese Medicaid patients who undergo Roux-en-Y gastric bypass surgery may be more likely to return to work than similar patients who don't have the surgery.

Researchers at the Virginia Mason Medical Center, Seattle, studied 38 medically disabled patients who had the surgery and 16 patients who did not.

Those who had surgery, average age 48, had an average body mass index of 58 before surgery and were followed for about 44 months. Those who did not have surgery, average age 51, had an average BMI of 54 and were followed for about 32 months.

"The patients who underwent Roux-en-Y gastric bypass were more likely to return to work, with 14 (37 percent) working, compared with 1 (6 percent) of the non-operative control patients," the study authors wrote. "Return to work was more likely in patients who had resolution of comorbid conditions (co-occurring illnesses) after surgery."

The patients who returned to work no longer needed Medicare funding.

While bariatric surgery has become more widely accepted, additional research is needed to prove to insurers and the public that it is the best long-term treatment for obesity, according to an editorial that said these bariatric surgery studies help improve understanding.

"The studies presented in this issue of the Archives provide us with more knowledge about these procedures' risks, outcomes, complication profiles, improved functionality associated with surgically induced weight loss, need for long-term monitoring and equivalency of the various laparoscopic banding operations," wrote Dr. Edward H. Livingston of the University of Texas Southwestern Medical Center at Dallas. "However, we will need more to convince the non-believers in bariatric surgery that it is the appropriate therapy for morbidly obese patients who have, or may develop, complications from their excessive weight."

More information

MedlinePlus explains gastric bypass surgery.

Posted: October 2007


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