Gastric Bypass

Gastric bypass surgery is on the rise, and so too are the rates of hospitalizations and early postoperative deaths related to complications. "Medical interventions for weight loss do not have such dramatic and persistent weight loss associated with them, making surgical intervention attractive to individuals who have been unable to successfully lose weight," wrote David S. Zingmond, M.D., Ph.D., and colleagues at the University of California at Los Angeles. But those interventions -- while reducing the frequency of associated conditions such as diabetes, hyperlipidemia, hypertension, and sleep apnea -- come at a price. In a retrospective study of 66,077 California patients who underwent Roux-en-Y gastric bypass surgery from 1995 to 2004, the rate of hospitalization in the year following surgery was more than double that in the year before bypass, Dr. Zingmond and colleagues reported. Among nearly 25,000 bypass surgery candidates for whom three-year follow-up data were available, a mean of 8.4% were admitted to the hospital a year before surgery, primarily for obesity-related problems such as osteoarthritis, and cellulitis of the lower extremities. In contrast, 20.2% of patients were hospitalized in the year after surgery, 18.4% in the second year, and 14.9% in the third. Postsurgical hospitalizations tended to be for complications that were likely related to surgery, such as gastric revision and ventral hernia repair, the investigators noted. A second study of bariatric surgery performed on Medicare beneficiaries found that risk of death within one year of surgery is higher than that suggested by other studies, and that among patients 65 and older the risk of early death is nearly three times greater than that of younger patients. David. R. Flum, M.D., M.P.H., and colleagues at the University of Washington in Seattle took a retrospective look at data on 16,155 patients (mean age 47.7 years) who underwent bariatric surgery. They found that in contrast to other series, which suggested a perioperative death rate of about 0.5%, the rates of 30-day, 90-day, and one-year mortality were 2.0%, 2.8%, and 4.6%, respectively. At every time point, men were about twice as likely to die as women (3.7% vs 1.5%, at 30 days, 4.8% vs. 2.1%, at 90 days, and 7.5% vs 3.7% at one year, P<0.001). Summarizing, the rate of hospitalization in the year following surgery was more than double that in the year before bypass. The rates of 30-day, 90-day, and one-year mortality were 2.0%, 2.8%, and 4.6%, respectively. The risk of post operative death is even higher for those over 65. There were an estimated 13,365 gastric bypasses performed in 1998 and 72,177 in 2002. Experience and technique of the performing surgeon are crucial factors for a successful outcome. "These studies demonstrate that there are vulnerable patient populations and potential additional costs associated with surgery but suggest that surgical volume helps mitigate these risks and costs," wrote Bruce M. Wolfe, M.D., of Oregon Health & Sciences University in Portland and John M. Morton, M.D., M.P.H., of Stanford in an accompanying editorial.