By LEE BOWMAN
Scripps Howard News Service
October 19, 2005
However, the procedures increase the odds that people will wind up back in the hospital and are particularly risky for Medicare patients, the studies found.
With the majority of adults in the country overweight or obese, the number of weight reduction surgeries - primarily gastric bypass procedures that shrink the stomach - has soared from 13,360 in 1998 to a projected 130,000 procedures this year, according to researchers from the University of Chicago and the University of California-Irvine.
In the past two decades, the proportion of Americans who are at least 100 pounds above their recommended weight, or with a Body Mass Index of 40 or greater, has quadrupled, to 1 in 50. This amount of excess weight is considered one of the benchmarks for considering obesity surgery.
In their report in The Journal of the American Medical Association, the researchers said that along with the dramatic increase in the number of the surgeries, there is also a trend toward people who are wealthier and covered by private health insurance having the surgery done.
A second study in JAMA, led by Dr. David Flum of the University of Washington, Seattle, found that after taking into account sex and the extent of illness faced by patients, the odds of patients aged 65 and older dying within 90 days of weight loss surgery was three times greater than among younger patients (6.9 percent versus 2.3 percent.)
Patients aged 75 and older were 5 times more likely to die within 90 days after the surgery than in younger populations.
"The risk of death is much higher than has been reported,'' Flum said. "It's a reality check for those patients who are considering these operations."
The study involved more than 16,000 Medicare patients who had obesity surgery between 1997 and 2002 - most of them actually under 65 but covered under the federal health program because they were disabled. Medicare pays for the surgery when its recommended by a doctor to help related conditions such as diabetes and heart disease, but so far not just to correct obesity.
Flum noted that older patients generally don't tolerate the stress of surgery as well as younger people, and may get less benefit from the surgery because damage to organs such as the heart and lungs from obesity may have been present for a longer period of time.
Experts in the field caution that weight-loss surgery is so new and the techniques, particularly for the most common operations that reduce the size of the stomach, still evolving, that it's difficult to say exactly which patients face the most risk or stand to benefit the most from the procedures.
One factor in complications from the surgery may be that many of the operations are done by doctors and hospitals who do too few of them to become proficient. The JAMA studies suggest that doing a higher volume of the surgeries reduces the risks and higher costs from complications down the road.
But "as long as bariatric surgery remains the only durable option for weight loss in the morbidly obese, we need to make an effort to ensure that all populations who suffer from morbid obesity have the same option of surgical weight loss, irrespective of insurance provider or income level,'' said Dr. Heena Santra, a resident at the University of Chicago Hospitals who led the surgical trends study.
By some estimates, two-thirds of the $90 billion a year in excess medical costs due to obesity are incurred by people who are eligible for weight-reduction surgery.
Another study, published Monday by the American Journal of Managed Care, calculates that if employers would more readily cover the operations for their workers with reasonable insurance co-pays, they could see a return in reduced health costs for their workers within five to 10 years.
But a third JAMA study that looked at the experience of more than 60,000 gastric bypass patients in California between 1995 and 2004, found that the patients had double the rate of hospitalization in the year following the surgery than in the year before they had the procedure.
The average hospital charges for the gastric bypass surgery itself were $33,672, while over the next three years; another $20,651 in average hospital costs was amassed. That compared to average hospital charges of just under $5,000 for the three years before the surgery.
So, "rather than expected a decrease in inpatient health utilization (after bypass surgery), the costs associated with hospitalization may remain elevated for as many as five years (after the surgery),'' said Dr. David Zingmond of the University of California-Los Angeles, lead author of the study.
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