TUESDAY, Oct. 18, 2005 (HealthDay News) -- Given the rising rates of obesity in the United States, it's not surprising that more people are turning to bariatric surgery to treat the problem.
But several new studies in the Oct. 19 issue of the Journal of the American Medical Association point out some of the real risks associated with those surgeries.
One study found rehospitalization rates within a year following the surgery were as high as 19 percent. And another study looked at death rates for Medicare recipients following gastric-bypass surgery, and discovered the mortality rate was almost 5 percent after a year. A third study examined trends in bariatric surgery, and found the number of bariatric surgeries have increased dramatically, from 13,365 in 1998 to an estimated 102,794 in 2003.
"I was not surprised by these findings. These studies are really a very small piece of the overall picture for bariatric surgery," said 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.
"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," said Livingston, who added that the decision about whether to have the surgery is a complicated one, and needs to be made on a case-by-case basis.
"For some patients, bariatric surgery is probably the way to go," he added.
Those generally considered candidates for obesity surgery are people with a body mass index (BMI) over 40, which usually means about 100 pounds overweight for a man and 80 pounds overweight for a woman, according to the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK). People with lower BMIs are also considered candidates for the surgery if they have obesity-related health problems, such as type 2 diabetes, severe sleep apnea or heart disease, according to NIDDK.
The most commonly performed inpatient bariatric surgery is called the Roux-en-Y gastric-bypass. In this procedure, the stomach is made smaller, and a part of the small intestine is bypassed so that fewer calories and nutrients are absorbed, according to NIDDK. Among the risks from this procedure are infection, hernia and long-term nutritional deficiencies.
Still, more and more of these operations are being done. The study of trends in bariatric surgery, done by researchers from the University of Chicago and the University of California, Irvine, found more than a fivefold increase in the number of bariatric surgeries performed in the United States between 1998 and 2002, and they predicted that more than 100,000 people will soon have the procedure annually. A majority of the procedures are done on women (84 percent) and those with private insurance (83 percent), according to the study.
Among those with public insurance, another study looked at the mortality rates for those on Medicare who undergo bariatric surgery. They found the death rate after 30 days was 2 percent for Medicare recipients. After 90 days, that rate was 2.8 percent and after a year, the death rate for bariatric surgery patients receiving Medicare benefits was 4.6 percent. 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 University of Washington authors.
Livingston said these results aren't surprising because the Medicare population is either elderly or disabled, which means they're generally not as healthy as younger patients.
The final study, which included all California residents (60,077) who had undergone bariatric surgery from 1995 through 2004 , also found a higher mortality rate in Medicare patients. The overall in-hospital mortality rate was 0.18 percent, but 0.64 percent for Medicare patients.
However, this study was designed to look at rehospitalization rates, and found that rehospitalization rates were 19.3 percent in the year following bariatric surgery. Rates of hospitalization in the year prior to the surgery were only 7.9 percent, according to the study. The most common reasons for being admitted to the hospital prior to the surgery were obesity-related problems. After the surgery, the most common reasons for hospitalizations were surgery-related, such as for hernia repair.
"These findings indicate more morbidity in the initial three years after surgery. People should be aware when they're making this decision that this is a possibility," said study author Dr. David Zingmond, an assistant professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles Center for Surgical Outcomes and Quality.
To learn more about surgery for obesity, visit the National Institute of Diabetes and Digestive and Kidney Diseases.