STATE PANEL REPORTS ON WEIGHT LOSS SURGERY OUTCOMES
Makes Recommendations To Ensure Patient Safety As Number Of Procedures Rise
By Rhonda Mann
Beth Israel Deaconess Medical Center Staff

As the number of weight loss procedures performed in Massachusetts continues to rise, the death rate for patients within days of the procedure has never been lower, according to a new state-issued report.

The Betsy Lehman Center’s Expert Panel on Weight Loss Surgery just released its updated recommendations. The report found that despite a14 percent growth in the number of weight loss surgeries performed in Massachusetts between 2004 and 2006, the inpatient death rate fell to .07 percent, significantly below the national inpatient death rate.

“We’re doing a good job in this state of providing the latest, most effective, and safest surgical procedures to combat obesity,” says George Blackburn, MD, PhD, from Beth Israel Deaconess Medical Center, chairman of the Expert Panel. “But we have an older, heavier population and a rapidly-evolving surgical specialty,” he explained, “factors that make it more critical than ever to protect the well-being of patients who undergo weight loss surgery.”

Nationwide, the number of weight loss operations climbed 800 percent between 1998 and 2004 and grew another 11 percent between 2005 and 2006 with more than 200,000 procedures performed during that two year period. In Massachusetts, the number grew from 3,036 procedures in 2004 to 3,447 in 2006.

Across all age groups, the fastest growth occurred among adults aged 55 to 64, with a 20-fold increase between 1998 and 2004 nationally. Length of hospital stay fell by more than 38 percent from nearly 5 days to 3.1 days. Not surprisingly, the oldest patients had the longest length of stay and the highest inpatient mortality rate.

Despite the growing numbers of surgeries and the increased safety profile, the report found that 99 percent of patients who are eligible for weight loss surgery do not receive it.

“Overwhelming new data highlighted in this report demonstrate reductions in known disease risk factors, improvements in health and significant reductions in mortality after weight loss surgery,” says John Auerbach, Commissioner of the Massachusetts Department of Public Health. “We expect this report to continue to set the standard for improving the safety of weight loss surgery in the Commonwealth and beyond.”

Proven benefits of weight loss surgery include decreases in blood pressure and cholesterol, diabetes, sleep apnea and other obesity-related illnesses. A study from Sweden highlighted in the report showed a 31 percent reduction in adjusted overall mortality in the surgical groups compared to obese patients who had no surgery. “In the year 2000, more than 360,000 deaths in this country were attributed to obesity-related diseases,” says Dan Jones, MD, co-chair of the subcommittee charged with developing new ways of collecting data on weight loss surgery patients. “Now that multiple studies have clearly shown a survival advantage after intervening with weight loss surgery, it’s no longer acceptable for physicians to ignore discussing obesity in the doctors office.”

While there are more than 200 published studies on the health benefits associated with weight loss surgery, data collection and reporting is scattered. In the report, the Panel called this a key factor in patient safety and recommended enhanced, across-the-board data collection criteria and systems to better track outcomes.

But there is more that still needs to be learned. The report notes a 58 percent greater death rate from non-disease causes (such as accidents and suicide) in obese patients who underwent weight loss surgery. Previous studies have suggested a link between weight loss surgery and an increase in drug or alcohol abuse.

In 2004, the increased demand for weight loss procedures prompted the then commissioner of public health to request the formation of an expert panel to review their safety. The initial review called for stricter credentialing/training of surgeons, and suggested patient outcomes were better in high volume medical facilities—those that performed more than 50 cases per year.

This new review, a six-month effort involving more than 100 specialists from across the state and across the many disciplines involved in the field of weight loss surgery, provides updated recommendations.

New findings from the report show that:

- Laparoscopy has displaced open surgery as the predominant approach
- Weight loss surgery accreditation/credentialing programs have been established within the past three years
- Optimal treatment requires greater collaboration between members of a multidisciplinary care team
- Wide-ranging changes in new and existing health care facilities will be needed to accommodate the growing numbers of severely obese patients
- The Centers for Medicare and Medicaid Services and other payers only reimburse procedures performed at accredited weight loss surgery centers.

“With up to one in ten U.S. adults potential candidates for weight loss surgery,” “it’s imperative to promote widespread implementation of best practice care.” says Dr. Blackburn. These recommendations, which are based on a comprehensive review of the best and most current literature on weight loss surgery, are designed to do just that.”

For the full report, click here. The panel has also provided patient information on weight loss surgery including questions to ask your surgeon.