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Obesity surgery: A costly `after'

Even as bariatric surgery's popularity skyrockets, a new study finds that nearly half of all patients experience complications.

July 31, 2006|Melissa Healy | Times Staff Writer

The before-and-after pictures are striking and seductive, and Americans love a quick fix almost as much as they love a heaping buffet. As a result, the United States has seen explosive growth in the popularity of bariatric surgery.

The procedures, which reshape the gastrointestinal tract to limit a patient's intake and absorption of calories, have jumped from some 13,000 in 1998 to a predicted 170,000 this year. And that, say physicians who perform the surgery, may be less than 1% of those who could benefit from the operation.

But for all the inspirational stories of lives transformed -- and a growing parade of celebrity testimonials (Randy Jackson, Sharon Osbourne, Roseanne Barr, opera star Deborah Voigt) -- weight-loss surgery is serious stuff, with the price tag and medical risks to show for it. A flurry of recent studies has been a sobering reminder of that.

Men, patients older than 45, and those with hypertension are more likely to die after bariatric surgery than earlier studies had shown. Elderly patients benefit least and are twice as likely to die after bariatric surgery than those who get hip replacements and surgery to replace or repair coronary arteries. Obese patients given to "emotional eating" have lower rates of success after the surgery. And, in some patients, vitamin A deficiencies are showing up years down the road.

Now, the Agency for Healthcare Research and Quality -- an arm of the federal government's public health service -- has revealed that, in 2001-2002, about four in 10 bariatric surgery patients experienced significant complications in the 180 days after their operation. Although the overall death rate among these patients was low, 7.2% of the 2,522 patients studied had to be readmitted to the hospital within 180 days after surgery.

Collectively, the studies could temper enthusiasm for a weight-loss solution undergoing rapid change as well as explosive growth. They also may significantly slow the decisions of states and private insurers to cover the costs of weight-loss surgery. At the same time, the studies are being forcefully countered by bariatric surgeons, who assert that their fast-moving profession has left many identified problems behind.

The new study shows that postoperative complications pushed costs for bariatric surgery upward considerably. For those who experienced a complication, average costs climbed from $25,337 per patient to $36,542. For those who were readmitted to the hospital for complications, the total bill averaged $65,031.

"This study shows how important it is for patients to consider the potential complications" of bariatric surgery, said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality.

Those cost numbers, released last week, are likely to be of particular interest to the federal agency that oversees Medicare, which in February agreed to cover bariatric surgery for certain patients under the age of 60. Medicare also requires that surgery be performed in surgical centers and by physicians accredited in the procedures. Coverage of bariatric surgery for those on Medicaid (Medi-Cal in California) varies from state to state, and many states are considering whether and under what conditions to cover such operations. Since 1989, Medi-Cal has paid for such surgery for patients over 21 with a doctor's recommendation.

Most common -- 20% of those with complications -- were patients with evidence of "dumping syndrome," in which undigested food is moved too quickly into the small intestine, causing vomiting, reflux and diarrhea. But 12% of those with complications suffered leaks or strictures at the site where the stomach and the intestine have been surgically fused, and 7% suffered from abdominal hernias.

The latest study -- and many of those that have come before it -- have elicited strong objections from leaders in the field of bariatric surgery, who have called them outdated, shoddy and unnecessarily alarming.

"I think it's way dated, and I think it's very inaccurate," said Dr. Harvey Sugerman, who chairs a new committee established by the American Society for Bariatric Surgery to accredit centers and surgeons performing the procedures.

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