Obesity Surgery Often Leads to Complications, Study Says
By ROBERT PEAR, July 24, 2006
WASHINGTON, July 23 �?Four of every 10 patients who undergo weight-loss surgery develop complications within six months, the federal government said Sunday.
The number of such surgical procedures has been rising rapidly, along with the incidence of obesity, which now afflicts 30 percent of adults in the United States, health officials said.
Obesity surgery is helping thousands of Americans lose weight and reduce the risk of diabetes and other life-threatening diseases, said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, a unit of the Public Health Service. But she added, “This study shows how important it is for patients to consider the potential complications.�?/FONT>
Many of the complications were so serious that patients were readmitted to hospitals or visited emergency rooms within six months.
In the procedure, known as bariatric surgery, doctors reduce the number of calories that a person can consume and absorb. One of the more common techniques restricts the size of the stomach and the length of the intestine, where nutrients are absorbed.
Federal researchers found that complications from obesity surgery significantly increased costs.
Over all, said William E. Encinosa, an economist at the health research agency, medical spending averaged $29,921 for obesity surgery and six months of follow-up care. For patients who experienced complications, spending averaged $36,542. And for those with complications that required readmission to a hospital, the average was $65,031.
Past studies found that 10 percent to 20 percent of patients had complications while they were in the hospital. In the new study, Mr. Encinosa said, federal researchers found that 39.6 percent of patients had complications within 180 days of surgery.
The most common complications included vomiting, diarrhea, abdominal hernias, infections, pneumonia and respiratory failure, as well as the leaking of gastric juices caused by imperfect surgical connections between the stomach and the intestines.
Joanne Kayser, a retired New Hampshire state employee, said she weighed 320 pounds when she had weight-loss surgery in 2003. “The operation went well,�?she said in an interview. “It reduced my food intake. After the surgery, I lost 60 pounds.’�?/FONT>
But Ms. Kayser, now 64, said: “My incision did not heal for seven months. I could not exercise, and I stopped losing weight. The incision became infected, and I had to have surgery by a wound care specialist. In addition, after four months, I developed a hernia, a bulge in my tummy.’�?/FONT>
Bariatric surgery often alleviates conditions that occur with obesity, like diabetes, high blood pressure and high cholesterol. That was the case with Ms. Kayser, who said she no longer needed to take diabetes medications because her blood sugar levels were under control.
Dr. Philip R. Schauer, president of the American Society for Bariatric Surgery, estimates that 175,000 to 200,000 weight-loss procedures will be performed this year, up from 47,000 in 2001. The number of people receiving the operation “may be less than 1 percent of those who need it,’�?said Dr. Schauer, director of bariatric surgery at the Cleveland Clinic.
The government study was based on insurance claims filed with health plans offered by 45 large employers in 49 states. The data included information on 2,522 weight-loss operations in 2001 and 2002.
Dr. Schauer said surgical techniques and the quality of care had improved, so patients were less likely to suffer complications. In 2001 and 2002, he said, “there were not a lot of standards for doctors and hospitals getting into the field of bariatric surgery.�?Since then, he said, the society has adopted standards, and some hospitals that specialize in the procedure have been designated “centers of excellence.�?/FONT>
In addition, Dr. Schauer said, more than half of the operations are now done with a technique known as laparoscopic surgery, which requires only tiny incisions. This approach sharply reduces some types of complications, he said.
In the cases reviewed by federal researchers, 85 percent of the patients were women.
Dr. Schauer suggested several reasons: “Women have a somewhat higher incidence of obesity. Women seek medical care more than men. And obesity is more socially acceptable in men than in women.�?But Dr. Schauer said, “Obesity is more deadly in men because they are more likely to have secondary effects of obesity like heart disease, high blood pressure and diabetes.�?/FONT>
Arthur G. Richards, an insurance agent in Portland, Ore., said some insurers were refusing to pay for obesity surgery and its complications. Such complications can lead to lawsuits, even when doctors meet the prevailing standards of care. Mr. Richards said his company was developing special insurance policies that would pay doctors for treating foreseeable complications.
From: http://www.nytimes.com/2006/07/24/health/24health.html?ex=1153972800&en=370c948ad74c4dcc&ei=5087%0A
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