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Older and Medically Disabled Patients Have Higher Mortality from Bariatric Surgery: Presented at ACS
By Crystal Phend
SAN FRANCISCO -- October 24, 2005 -- Older and medically disabled patients undergoing bariatric surgery have higher mortality rates than typically reported for the weight loss surgery, according to a study presented here at the American College of Surgeons (ACS) annual meeting.
"The Medicare population rate of early death after gastric bypass is higher than some would suggest," said lead author David R. Flum, MD, MPH, Director, Surgical Outcomes Research Center, and Associate Professor, University of Washington, Seattle, Washington, United States.
Most reported mortality rates for bariatric surgery in the general population fall between 0.5% and 1.5% while in-hospital mortality is 0.3% to 0.9%.
For their study, Dr. Flum and colleagues used the U.S. Medicare program for the elderly and medically disabled to estimate bariatric surgery outcomes for high risk patients. Dr. Flum emphasized that the results do not reflect risk in the general population.
The researchers studied records of 16,155 patients in the administrative database of Part B Medicare. Most of the patients were female (75%) and younger than 65 (90.6%). The most common bariatric procedure on these patients was Roux-en-y gastroenterostomy (61.2%).
Overall, mortality rates were 2.0% at 30 days, 2.8% at 90 days, and 4.6% at 1 year. Men had a significantly higher risk than women at 30 days (3.7% vs. 1.5%), 90 days (4.8% vs. 2.1%) and 1 year (7.5% vs. 3.7%).
Older patients had a 3-fold higher mortality rate. Patients older than 65 had higher risk at all time points (4.8% vs. 1.7% at 30 days, 6.9% versus 2.3% at 90 days, and 11.1% compared to 3.9% at 1 year). Those older than 75 years had an "exaggerated mortality rate," Dr. Flum said.
"It makes me even more convinced that this type of procedure should be offered only selectively to older patients," he said.
However, risk was lower for all patients when stratified by increasingly experienced surgeons.
"Directing care of older patients to surgeons who perform higher volume of bariatric procedures in Medicare beneficiaries might be expected to improve outcomes in this high-risk population," the researchers wrote in their Journal of the American Medical Association article published the same day.
[Presentation title: Early Mortality among Medicare Beneficiaries Undergoing "Open" Bariatric Surgery. General Session 63]
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