- The Washington Times - Tuesday, October 18, 2005

CHICAGO (AP) — The chances of dying within a year after obesity surgery are much higher than previously thought, a study of more than 16,000 Medicare patients found.

Some previous studies of people in their 30s to their 50s — the most common age range for obesity surgery — found death rates were less than 1 percent. But among 35- to 44-year-olds in the Medicare study, more than 5 percent of men and nearly 3 percent of women died within a year, and slightly higher rates were seen in patients 45 to 54.

Among patients 65 to 74, nearly 13 percent of men and about 6 percent of women died. In patients 75 and older, half of the men and 40 percent of the women died.

“The risk of death is much higher than has been reported,” said University of Washington surgeon Dr. David Flum, the Medicare study’s lead author. “It’s a reality check for those patients who are considering these operations.”

The study involved 16,155 Medicare patients who underwent obesity surgery between 1997 and 2002. It was published in today’s Journal of the American Medical Association (JAMA).

The study included all deaths, with no breakdown of the causes. Obesity surgery’s deadly complications can include malnutrition, infection, and bowel and gallbladder problems. Also, surgery in general can be a deadly shock to the system, especially in older patients.

Dr. Neil Hutcher, president of the American Society for Bariatric Surgery (ASBS), said Medicare patients are probably sicker than the general U.S. population and that complication rates have declined as surgeons’ expertise has increased.

But Dr. Flum said some previous research on the safety of obesity surgery consisted of “reports from the best surgeons reporting their best results,” while the latest study is more of a real-world look.

The ASBS predicts obesity surgery will be performed more than 150,000 times this year in the United States. That is more than 10 times the number in 1998, a second JAMA study said. The increase parallels a surge in the share of American adults who are at least 100 pounds overweight, from about one in 200 in 1986 to one in 50 in 2000, according to that study.

Supporters of stomach-reduction surgery for people who are grossly overweight say the operation can save their lives by reducing the workload on the heart and lungs and eliminating related illnesses, such as diabetes and sleep apnea.

Dr. Flum said the new study suggests that in many cases, obesity surgery may not be right for an older person “who already has the burden of 60 years of obesity on their heart” and other organs.

Medicare covers obesity surgery if it is recommended to treat related conditions such as diabetes and heart problems. The government is considering whether to cover surgery to treat obesity alone.

Dr. Hutcher said patients should seek experienced surgeons who meet his group’s guidelines. Those include thoroughly evaluating patients before and after surgery and giving them long-term follow-up care.

Most patients “will receive a good outcome. A good outcome does not mean there’s no risk for complications or mortality,” he said.

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