Risk of Death Within 30 Days After Bariatric Surgery

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Bariatric Weight Loss Surgery Risk

A study of 29 academic health centers in the United States indicates that the risk of dying within 30 days after bariatric surgery is less than 1 percent, according to a study in the May issue of the Archives of Surgery, one of the JAMA/Archives journals.

Bariatric surgery for weight loss has become increasingly popular, leading to scrutiny regarding the safety of the various types of procedures, according to background information in the article. Studies based at individual facilities providing bariatric surgery procedures have indicated that the rates of complications and death are low, but reports using broader data suggest that the procedure might be less safe on a local or national level.

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Ninh T. Nguyen, M.D., University of California-Irvine Medical Center, Orange, and colleagues analyzed the medical records of 1,144 patients who had undergone bariatric surgery at 29 academic medical centers between Oct. 1, 2003, and March 31, 2004; 40 consecutive cases from each center were included in the study. All of the patients were between the ages of 17 and 65 years and had a body mass index (BMI, calculated by dividing the patients' weights in kilograms by the square of the heights in meters) of 35 to 70. Most of the patients (91.7 percent) underwent gastric bypass surgery, which involves sectioning off a small portion of the stomach into a pouch that connects directly to the small intestine. About 8 percent had restrictive procedures, including gastric banding, which involves placing a band-like device around the stomach, which divides the stomach into two smaller compartments.

Among gastric bypass patients, a total of four patients (.4 percent) died within 30 days of the procedure, including .2 percent who died in the hospital. Sixteen percent of gastric bypass patients developed complications, including leakage at the anastomosis site (the suture line at the newly created attachment site of the stomach and intestine), wound infection, pneumonia, irregular heartbeat, intestinal obstruction or urinary tract infection. Three-quarters of the gastric bypass procedures were performed laparoscopically, in which the surgeon performs the procedure using a laparoscope inserted via small incisions. Among patients receiving restrictive procedures, the 30-day death rate was 0 percent and the complication rate was 3.2 percent. Almost all-92 percent-of restrictive procedures were performed laparoscopically.

"This analysis demonstrates that bariatric surgery at predominately high-volume academic centers and in a subset of patients with BMI of 35 to 70 is associated with low morbidity and mortality," the authors conclude. "The practice of bariatric surgery at academic centers has shifted from open surgery to laparoscopic surgery, with gastric bypass the primary bariatric surgical procedure. Data from this quality-controlled study can be used as a benchmark for the practice of bariatric surgery at most U.S. hospitals. In the future, there should be emphasis toward a prospective, clinically derived database for collection of bariatric surgery outcomes as a vehicle for quality improvement." (Arch Surg. 2006;141:445-450)

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