Potential dangers of bariatric surgery

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Bariatric surgery, while providing hope for health among those that are obese, does have its potential dangers. According to a recent study published in the October edition of Archives of Surgery, approximately 1% of all bariatric surgery patients die within the first year of having the surgery and another 5% die within five years. When analyzing data surrounding patients receiving bariatric surgery in Pennsylvania from 1995 to 2004, researchers found that there were many deaths after the surgery that were not attributed to physical health but rather suicide.

The findings imply that more concentrated follow up could help reduce the death rate in bariatric patients in the long term after surgery. In particular, screening for depression would be key to such a follow up effort. However, clinicians would be well suited to watch for signs of diabetes and hypertension as well. It should be said after discussing the study’s findings that the risk of not having the surgery often outweighs the risk involved in the surgery itself, especially in cases where candidates for the surgery are morbidly obese. The following is an excerpt of an article from Psychiatric Times that reviews the study’s findings:

Starting with 32 procedures in 1995, 74 hospitals in the state performed steadily increasing numbers, peaking at 4,778 in 2003, before dropping back slightly to 3,818 in 2004.

All told, there have been 440 deaths recorded after 16,683 procedures, the researchers found.

The 30-day case fatality percentage was 0.9% overall. The rate increased with the age of the patient, reaching 3.1% for those 65 and older. There was no evidence that the 30-day fatality rate changed over time.

While 74 hospitals performed bariatric surgery, 90.3% of the procedures took place in just 32 hospitals and 48.2% in only eight, the researchers noted.

Of the 440 deaths, 82.7% took place among the patients of the 32 hospitals that contributed more than 90% of the procedures, Dr. Kuller and colleagues said.

Among the 440 deaths, there were 45 that the researchers defined as traumatic, including 16 due to suicide, 14 due to drug overdoses that were not classified as suicide, 10 due to motor vehicle crashes, three to homicide, and two to falls.

Based on U.S. vital statistics, the researchers estimated that three suicides should have occurred in this population, instead of the 16 that were seen. “There is a substantial excess of suicide deaths, even excluding those listed only as drug overdose,” they said.

Among the remaining 395 deaths, the leading cause was coronary heart disease at 19.2%, followed by sepsis at 13.9%, pulmonary embolism at 11.9%, therapeutic complications at 11.4%, and cancer at 10.6%.

In his critique, Dr. Livingston pointed out that “lacking randomized trials, the effect of bariatric surgery on obesity-related mortality is inferential at best.”

“What was unexpected,” he said, “was the frequency of suicide and drug overdoses.”

Click here to read the entire article from Psychiatric Times

Click here for information on treatment options for depression

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