Bariatric Surgery Now Safer, Patient Database Reveals

The Michigan Bariatric Surgery Collaborative, a patient database funded by a $700,000 annual grant from Blue Cross Blue Shield of Michigan, sheds new light on the safety of bariatric surgery. [The statistics are the first in a three-year project and it may be too early to draw conclusions, warns David Share, a director of health care quality at Blue Cross.]

Doctors perform 140,000 gastric bypass surgeries in the U.S. each year, according to the American Society for Bariatric Surgery. The most common types are lap-band, minimally invasive gastric bypass and open gastric bypass.

Patient education may increase bariatric surgery acceptance

About 1% of patients who are candidates for gastric bypass surgery actually have the procedure. Mortality risk has been cited a major deterrent to broader use.

Of the three most common types of bariatric surgery, lap-band appears to carry less risk of surgery-related death, though data is mixed. Lap-band patients were more likely than gastric bypass patients to need oral diabetes, blood pressure and diuretic medicines one year after surgery, according to the registry.

Between July 2006 and June 1st, 12 Michigan patients died from problems associated with bariatric surgery. Seven had minimally invasive gastric bypass surgery, four had open gastric bypass and one underwent a lap-band procedure.

Minimally invasive gastric bypass carried the highest rates of reoperations, extended hospital stays, deaths and other adverse events. Still, the rate of life-threatening events was only 0.5%, compared to 2% in 2000 (according to national statistics).

Lap-band, the most common bariatric procedure, employs an inflatable silicone prosthetic device that is placed around the top portion of the stomach, usually via laparoscopic surgery (see the video).

While it is the safest procedure, lap-band surgery patients lost weight more slowly (that’s not a bad thing, in this author’s opinion). After a one-year follow up, patients lost an average of 57 pounds with lap-band surgery, 102 pounds after minimally invasive gastric bypass and 118 pounds after open gastric bypass.

As an incentive to participate, Blue Cross gave as much as $200,000 a year in additional reimbursements to hospitals. Clearly, there’s a lot at stake for insurers. Nearly 40 million U.S. adults are classified as obese. Of these, it is estimated that four million are severely obese and 1.5 million are morbidly obese (BMI > 40).

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