Weight loss surgery safe, beneficial: study

Vemulapalli is director of bariatric surgery and an associate professor of surgery at the Montefiore Medical Center of the University Hospital for the Albert Einstein College of Medicine in New York. She was not involved in the study.

“Those of us doing bariatric surgery have seen this with our own patients and in studies that have been published in the literature but this meta-analysis simply ties that data together and has wrapped the impression like a present in a neat package,” she said.

Vemulapalli said there are currently about 200,000 weight loss procedures performed each year. She said the most common procedures are the gastric bypass, the sleeve gastrectomy and, to a lesser extent, the adjustable gastric band.

As popular as bariatric surgery has become - each year, more than 200,000 people undergo stomach-shrinking procedures in an effort to lose weight - the reality is that there is still little information about which patients should be getting the surgeries or how effective they really are as a treatment for obesity.

That may change with BOLD, the Bariatric Outcomes Longitudinal Database, the first repository of patient information and outcomes related to bariatric surgery - procedures that include gastric bypass, in which the bulk of the stomach is tied off and food is rerouted directly to the bottom half of the intestine, and gastric banding, in which the stomach is simply squeezed into a smaller size with a rubber-band-like device. In the first phase of results released by BOLD at the annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), researchers reported safety data indicating that bariatric surgery is no riskier than other common abdominal and GI procedures, with an overall mortality risk within 90 days of 0.112%. Complication rates from bariatric procedures also put them in line with other common surgeries, such as hip replacements and gall bladder operations. “The clear message is that the very low mortality signals a high degree of safety compared to conventional thinking, particularly among the public, about the risks of bariatric surgery,” says Eric DeMaria, vice chair of the department of surgery at Duke University, who presented the data.

The data support what other studies have been documenting in recent years - that although bariatric surgery, like any surgery, is invasive and risky, it’s becoming safer. In 2004, a study in the Journal of the American Medical Association found that the risk of death from gastric bypass was 0.5% (the risk of dying within 90 days after a hip replacement is about 0.3%), and a government analysis revealed that complication rates, particularly infections, from bariatric surgery had declined 21% between 2002 and 2006.

That’s due in large part to a set of self-imposed safety standards that the ASMBS created several years ago. The society generated criteria for safety and quality of care, and invited all bariatric centers to meet them. Once centers met the standards - which include providing state-of-the-art equipment for operations as well as protocols for following up and measuring the outcomes of the surgeries - the centers were subjected to a site inspection. Upon passing, they earned certification as an ASMBS Center of Excellence.

Patient data from those centers make up BOLD. In the initial study, data from more than 57,000 patients undergoing bariatric surgery in 371 hospitals were included. In coming years, says DeMaria, researchers hope to mine the database for better information on the effectiveness of bariatric surgery in addressing weight loss and reducing the risk of other health problems, such as heart attack, stroke and diabetes, that are associated with excessive weight gain.

 

“The article itself was very well done, and shows that the surgeons and centers who do surgery know how to do the operations, know which patients to operate on and how to identify and treat complications,” she said, “All of this makes for safer surgery.”

SOURCE: JAMA Surgery, online December 18, 2013

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The Effectiveness and Risks of Bariatric SurgeryAn Updated Systematic Review and Meta-analysis, 2003-2012

Results  A total of 164 studies were included (37 randomized clinical trials and 127 observational studies). Analyses included 161 756 patients with a mean age of 44.56 years and body mass index of 45.62. We conducted random-effects and fixed-effect meta-analyses and meta-regression. In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%). Body mass index loss at 5 years postsurgery was 12 to 17. The complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%). Gastric bypass was more effective in weight loss but associated with more complications. Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass. Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.

Conclusions and Relevance  Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.

Su-Hsin Chang, PhD; Carolyn R. T. Stoll, MPH, MSW; Jihyun Song, PhD; J. Esteban Varela, MD, MPH; Christopher J. Eagon, MD; Graham A. Colditz, MD, DrPH

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