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Risks of gastric surgery

July 27, 2010 3:14:14 PM PDT
Bariatric surgeries for weight loss, including gastric bypass and adjustable gastric band procedures, are now the second most common abdominal operations performed in the United States. However, the safety and outcomes of these surgeries are still a concern. A new study in the state of Michigan shows that while complication rates remain low, serious complications are associated with the volume of procedures done in hospitals and by surgeons.

A little over a year ago Pam Heatlie underwent a bariatric procedure at the University of Michigan Medical Center and says it changed her life.

"I can walk all day long and my feet don't hurt. My niece wants to go to an amusement park this summer and I'm going to go with her and I'm not just going to stand and watch her. I'll be on the rides. I just feel free my life is mine again," Heatlie said.

Like Heatlie, many bariatric patients are having positive outcomes.

"At least in the state of Michigan, bariatric surgery is now remarkably safe," said Dr. Nancy J. O. Birkmeyer of University of Michigan, Ann Arbor.

Dr. Birkmeyer, from the University of Michigan, and co-authors studied the outcomes of more than 15,000 bariatric surgery patients across the state of Michigan from 2006 to 2009. The study appears in this week's JAMA, the Journal of the American Medical Association.

"Low volume hospitals and surgeons had a serious complication rate of four percent compared to two percent for high volume surgeons in hospitals," Dr. Birkmeyer said. She continued, "We found that there was no difference in rates of serious complications between centers of excellence and other hospitals."

The 25 hospitals and 62 surgeons involved in the study were also part of the Michigan bariatric surgery collaborative, a payer-funded clinical outcomes registry.

"They collect data on all their bariatric surgery patients and meet three times each year to go over those data and to plan quality improvement interventions." Dr. Birkmeyer said.

This study updates earlier ones that were based largely on hospital billing data, which researchers say is not very reliable when measuring surgical complications.

"With our study we now have very strong evidence that bariatric surgery outcomes are related to procedure volume and are not related to centers of excellence status," said Dr. Birkmeyer.

This also gives patients food for thought, when deciding on where to have the operation and who will operate.

"Patients should realize that centers for excellence have met certain safety standards for bariatric hospitals but that they are not necessarily the hospitals with the best outcomes" said Dr. Birkmeyer.

Pam Heatlie was in the majority, with a good outcome.

"It's not for everybody, but it has been a miracle for me," Heatlie said.

Researchers hope the results will spark other states to start collaborative quality improvement programs.


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