Showing posts with label death rate. Show all posts
Showing posts with label death rate. Show all posts

Wednesday, November 11, 2009

New study on gastric bypass found higher mortality rate


A study of over 850 weight loss surgery patients, 98.5 percent of whom were gastric bypass patients, found that in those of BMI 50 and higher (which is the average size for bariatric surgery patients), 2 percent died within 30 days, another 3.6 percent died within 90 days of surgery and another 5 percent died within a year of surgery.

These patients were operated on in 1 of 12 veteran's hospitals. The mean age was 54 and 70 percent of the cohort were men.

The death rate was higher in those with a BMI of 50 and comorbidities like heart disease, sleep apnea etc.

Researchers Lie et al concluded:

"The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery... These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with superobesity (BMI eq or greater than 50)."


Now of course, we know that all providers of gastric bypass will be sure to show their prospective patients this study and discuss not having a gastric bypass if they are over 50 and BMI 50 or higher and/or have heart disease, complex diabetes etc, right?

SOURCE: Arch Surg. 2009;144:914-920

Friday, August 07, 2009

Weight Loss surgery death rates down? No evidence of this!


An article on aol news with the headline of "Obesity Surgery death rates low" reads:

-Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.


Sounds good, doesn't it? Now you can have a gastric bypass and have it only be as risky as gall bladder surgery i.e. 1 death in 7000 surgeries.

But wait! First of all the study didn't exactly say that at all.

The finding of the study, another Dr David Flum study to be published in the NEJ on August 13th, which looked at the medical records of 3,412 gastric bypass patients and 1,198 given stomach bands i.e. adjustable lap band, was that there were 3 deaths in 1000 patients so that's still _a lot_ more risky than gall bladder surgery.

Flum's own studies of 62,000 gastric bypass patients 6 years ago, found that 1 in 50 died within 30 days.

The "less deaths now" are attributed to "newer methods" and lap surgery. However, if you average the very LOW death rate of the adjustable lap band surgery in with gastric bypass, that's far more likely where the lower death rate figures come from.

That is the death rate on adjustable lap band surgery is 1 in 7000 or the same as a gall bladder surgery. And I sincerely doubt the death rate on gastric bypass has been reduced that much in the 6 years since Flum's other study (report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]) which was never formally published and which concluded by comparing desperately ill fat people hospitalized for other reasons than WLS, that even with such a high death rate it was slightly more risky to be fat than to have a gastric bypass.

It's called "cooking the books" and it's easy to see how they arrived at those figures. In 1198 lap bands, there were likely no deaths! And in 3412 gastric bypasses, there were likely 68 deaths within 30 days of surgery, however they probably took the table death figure which is 1 percent so that's 34 deaths.

Now lump them all together and that's 34 deaths in 4610 WLS surgeries or 8 deaths in 1000 surgeries. That's still more than the 3 per 1000 surgeries they are claiming so more cooking must have occurred. Simply, I have read nothing about the study being randomized and greatly suspect it was not randomized which means they could pick and choose the members of the cohort. That is, at the 10 hospitals they studied, there were likely far more patients than 4610 who had WLS but many were not included in the study for this or that reason.

Anyway, you get the gist. The gastric bypass isn't likely, any safer than it was in Dr Flum's study, 6 years ago. They just uh..re-computed because the results from the 2003 study which studied 62,000 cases of gastric bypass done in one hospital, didn't look so good (2 percent death rate within 30 days).

Fortunately for those providing gastric bypass, few will "do the math" or notice that the study was not 'randomized'. Unfortunately for those patients who have gastric bypass which Dr Terry Simpson emphasizes is over 100 years old (is essentially a modified Billroth II surgery originally done for duodenal ulcer), many may go in thinking that by some magic, the gastric bypass is now "safer".

I would suggest those who question, go to Dr Simpson's website and listen to the part of his online seminar about why he prefers the lap band to the gastric bypass and duodenal switch.