Stomach stapling surgery to control obesity, which has grown dramatically in the United States, has a death rate for some groups of patients that is as much as five times higher than was previously thought, researchers report today.
About 4.6% of Medicare patients who undergo the surgery die the following year, with men and the elderly having the highest mortality, researchers from the University of Washington report today in the Journal of the American Medical Assn.
Researchers had previously believed the death rate to be less than 1%, about the same as that for surgery in general.
But a second, larger study by UCLA researchers showed an overall death rate of less than 1% among all Californians who underwent the surgery over a nine-year period.
That study also found a higher-than-expected rate of re-hospitalization after the procedure, suggesting that the surgery may not lower overall health costs.
Weight loss surgery "is the only effective intervention that we have, but it is a high-risk operation whose risks had not been really well described in previous studies," said Dr. David R. Flum of the University of Washington, who led the study on Medicare patients.
Most of the Medicare patients were placed at high risk by their medical conditions, most of which were the direct result of their morbid obesity, he said
"It is not surprising that there is a higher risk in these patients, but we have to go back to the balance of how well they would be doing if they didn't have the operation," Flum said.
Even with these patients, their risks can be reduced by at least a third if the procedure is performed by highly experienced surgeons, Flum's results showed.
And the risks can be further reduced if the patients undergo newer forms of weight loss surgery, such as laparoscopic banding of the stomach. That procedure, commonly called Lap-Band, has only one-tenth the death rate of older procedures and an equally low rate of complications, according to Dr. Carson Liu of the UCLA Medical Center.
Surgical intervention has become increasingly popular as the number of obese Americans has skyrocketed. Whereas dieting generally produces small, transient weight losses, surgery can produce dramatic, permanent losses of 100 pounds or more, accompanied by decreases in the risk of diabetes, heart disease and other ailments.
