Watch the News Tonight

[chichigirl 1]

I don't know where this will show, if it's local only or not, but I am currently watching the news and they are talking about having a new warning about the risks for gastric bypass surgery. I will post what they have to say after the report is given, but the way they're presenting it's not a positve report, but who knows with the media. It may be information we are already familiar with, I don't know, but I'll keep you posted. By the way, I am in Miami, FL, if anyone is in that news area it's being shown on Channel 4, CBS.

Cindy

[La_madam 20]

Yes I saw the commercial for it, it is on NBC Nightly news with Brian Williams tonight

[ReneBean 3]

You can link to it now and read the story...

http://www.msnbc.msn.com/id/9741907/

Here is the link to the JAMA study they mention:

http://jama.ama-assn.org/cgi/content/full/294/15/1903

[Tropicana 0]

I'm reading the study right now....I'm not sure if it includes patients that are banded. Read an excerpt of the study from JAMA.

"Patients were defined as having had bariatric surgery if they<SUP> </SUP>had a claim for any of the following procedures: (1) CPT code<SUP> </SUP>43842: gastric restrictive procedure without gastric bypass<SUP> </SUP>for morbid obesity; vertical-banded gastroplasty; (2) CPT code<SUP> </SUP>43843: gastric restrictive procedure without gastric bypass<SUP> </SUP>for morbid obesity; other than vertical-banded gastroplasty;<SUP> </SUP>(3) CPT code 43846: gastric restrictive procedure with gastric<SUP> </SUP>bypass for morbid obesity, with short-limbed (<100-cm) Roux-en-Y<SUP> </SUP>gastroenterostomy (RYGB); (4) CPT code 43847: gastric restrictive<SUP> </SUP>procedure with gastric bypass for morbid obesity with small<SUP> </SUP>intestine reconstruction to limit absorption (including long-limbed<SUP> </SUP>[100-cm] gastric bypass and distal bypasses such as biliopancreatic<SUP> </SUP>diversion); or (5) CPT code 43848: revision of gastric restrictive<SUP> </SUP>procedure for morbid obesity.<SUP> "</SUP>

<SUP></SUP>

<SUP></SUP>

[Tropicana 0]

"A total of 16 155 patients underwent bariatric surgical<SUP> </SUP>procedures (mean age, 47.7 years [sD, 11.3 years]; 75.8% women),<SUP> </SUP>with 90.6% younger than 65 years (Table 1). A total of 61.2%<SUP> </SUP>of cases were claims for RYGB and 19.9% were for RYGB with small<SUP> </SUP>intestine reconstruction to limit absorption (distal bypass).<SUP> </SUP>There was more than a 3-fold increase in the number of procedures<SUP> </SUP>performed from 1997 (n = 1464) to 2002 (n = 4814).<SUP> </SUP>The median number of bariatric procedures performed per surgeon<SUP> </SUP>(among Medicare beneficiaries over the 6-year period) was 35<SUP> </SUP>(interquartile range, 14-70).<SUP> "</SUP>

[Tropicana 0]

Only 345 cases were not bypass or vertical banding. So maybe 345 of those 16,155 were banded.

[Tropicana 0]

Operation Type:

Proximal gastric bypass 9906 (61.2%)

Distal gastric bypass 3234 (20.0%)

Vertical banded gastroplasty 1445 (8.9%)

Revisional bariatric surgery 1225 (7.6%)

Other 345 (2.1%)

[Tropicana 0]

"Among all patients, the rates of 30-day, 90-day, and 1-year<SUP> </SUP>mortality were 2.0%, 2.8%, and 4.6%, respectively. Advancing<SUP> </SUP>age and male sex were associated with early death after bariatric<SUP> </SUP>surgery (Table 2), with the highest rates of early mortality<SUP> </SUP>identified among older men. Overall, men were much more likely<SUP> </SUP>to die after bariatric surgery than women (3.7% vs 1.5%, 4.8%<SUP> </SUP>vs 2.1%, and 7.5% vs 3.7% for men and women at 30 days, 90 days,<SUP> </SUP>and 1 year, respectively; P<.001 for all time points). Mortality<SUP> </SUP>rates were greater for those aged 65 years or older (n = 1517)<SUP> </SUP>compared with younger patients (4.8% vs 1.7%, 6.9% vs 2.3%,<SUP> </SUP>and 11.1% vs 3.9% at 30 days, 90 days, and 1 year, respectively;<SUP> </SUP>P<.001 for all time points). We found no differences in early<SUP> </SUP>mortality rates between patients who had primary vs revision<SUP> </SUP>surgery (2.0% vs 1.5%, 2.8% vs 2.2%, and 4.6% vs 4.3% at 30<SUP> </SUP>days, 90 days, and 1 year, respectively; all P>.10"

"Patients undergoing procedures by surgeons with lower volume<SUP> </SUP>of bariatric procedures (less than the median of surgical volume<SUP> </SUP>among Medicare beneficiaries between 1997-2003) had a higher<SUP> </SUP>rate of mortality than those with at least median experience<SUP> </SUP>(3.3% vs 2.0%; P<.001). Patients aged 65 years or older had<SUP> </SUP>much higher rates of early death when undergoing surgery by<SUP> </SUP>surgeons within the lowest quartile of volume (Table 4) compared<SUP> </SUP>with those in the highest quartile (9% vs 1.1% at 30 days and<SUP> </SUP>13.8% vs 1.1% at 90 days; P<.001). Surgeons in the highest<SUP> </SUP>quartile of bariatric procedure volume had similar rates of<SUP> </SUP>early mortality in both younger and older patients (1.8% 90-day<SUP> </SUP>mortality in patients <65 years and 1.1% mortality in patients<SUP> </SUP>65 years; P = .40). The higher overall rates of death<SUP> </SUP>among older patients were attributable in part to a higher proportion<SUP> </SUP>(36%) of older patients undergoing surgery by surgeons within<SUP> </SUP>the lowest quartile of bariatric surgery volume compared with<SUP> </SUP>younger patients. The odds of a 90-day death were 1.6 times<SUP> </SUP>higher for patients of surgeons with lower volume (less than<SUP> </SUP>the median) after adjusting for age, sex, and Charlson Comorbidity<SUP> </SUP>Index score (95% CI, 1.3-2.0).<SUP> "</SUP>

<SUP></SUP>

<SUP>"</SUP>The hazard ratio for death (Figure) at any time after the procedure<SUP> </SUP>was 2.3 times greater for patients aged 65 years or older compared<SUP> </SUP>with younger patients (95% CI, 2.0-2.7), with 9.5% 5-year mortality<SUP> </SUP>in younger patients compared with 21.6% mortality in the older<SUP> </SUP>cohort (P<.001). The odds of 90-day death did not change<SUP> </SUP>significantly based on the year the procedure was performed,<SUP> </SUP>even after controlling for patient age, sex, and Charlson Comorbidity<SUP> </SUP>Index score (odds ratio, 1.0; 95% CI, 0.9-1.0).<SUP> "</SUP>

[Tropicana 0]

In summary...there is an increased mortality risk among elderly patients and patients who are worked on by inexpereinced surgeons during gastric bypass surgery.

Duh.

[ReneBean 3]

I think that the main point was that the death rate is not 1 in 200 - it can be as high as 9 in 200 if you are working with an inexperienced facility. That would be 1 in 23, folks... Scary.

I am somewhat surprised that they didn't break down the mortality rate by procedure... I guess that will be next month's study.

[Mikie in VA 0]

Wow-ReneBene & Tropicana--you both moved so fast w/responses. Very informative one.

Thanks for putting this info up here.

Mikie

[lovecats85 2]

I'm so glad I had you guys to break it down in plain English for me. I have a biology degree but I sure hate reading studies and numbers! Anyways, basically what I got out of the summarized news article was that some people die but it's mainly b/c of the co-mobidities. Duh.

[MochaWendy 0]

ANY surgery is risky, But I went for the GB as staying at 308#'s. The surgeon and my PCP, made sure that I was well aware of all the risks, the surgeon even stated " YOU CAN DIE, YOU CAN DIE,YOU CAN DIE" ----- I was a walking time bomb. I also went through just about every medical test before being approved for the surgey. They wanted to know everything that they possibly could before the surgery.

I am now, 2 1/2 years post op.

<TABLE class=outerborder cellPadding=10><TBODY><TR><TD>It is important to remember that there is risk with any surgery.

There are some specific risks associated with Bariatric Surgery.

• 10-20% of patients who have weight-loss operations require follow-up operations to correct complications. Abdominal hernias are the most common complications requiring follow-up surgery. Less common complications include breakdown of the staple line and stretched stomach outlets.
  
• More than one-third of obese patients who have gastric bypass surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after surgery. Many surgeons are opting to remove the gallbladder during the initial weight loss surgery.
  
• Nearly 30% of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if Vitamin and mineral intakes are maintained.
  
• Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. Women of childbearing potential should have a pregnancy test before having weight-loss surgery.
  

</TD></TR></TBODY></TABLE>

[princess_n_thep 2]

Just saw it on TV about 20 minutes ago here in Arizona. They actually mentioned the Lap Band and said it would make GB obsolete. I think the LB will gain in popularity but I don't think GB will ever be obsolete.

[liberty2003 0]

I am happy that they are just getting LAP-BAND out there to the world..The death rate is high..My mom is a nurse and @ her job there was six people who have had GB within a two year span..4 have died due to complications..

My mom knew all 4 of them...