Risks, benefits and efficacy of bariatric surgery

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Originally published in Insidermedicine

A new model that takes into account the risks of surgery, the risks of obesity, and the efficacy of bariatric surgery helps clarify which patients are likely to live longer as a result of this intervention. The research is published in the January issue of the Archives of Surgery.

Here are some recommendations regarding the use of bariatric surgery in obese patients, from the American College of Physicians:

• Consider it for patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions

• A doctor–patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gall bladder disease, and malabsorption.

• Refer patients to high-volume centers with surgeons experienced in bariatric surgery.

Researchers out of the University of Cincinnati Academic Health Center used data from the 2005 National Inpatient Survey to calculate in-hospital mortality risk associated with bariatric surgery. They calculated the excess risk of mortality associated with obesity using the 1991-1996 National Health Interview Survey linked to the National Death Index, and estimated the efficacy of bariatric surgery for weight loss based on a recent large observational trial.

Based on their model, a 42-year old woman with a body mass index (BMI) of 45 would gain an additional 2.95 years of life expectancy through bariatric surgery. Bariatric surgery had a baseline 30-day mortality of 0.2% and a baseline efficacy for reducing mortality of 53%. Surgery was no longer considered beneficial when surgical 30-day mortality exceeded 9.5% or when the efficacy of bariatric surgery for reducing mortality was decreased to 2% or less.

Today’s research provides a tool to help clinicians determine which of their obese patients will obtain a mortality benefit from bariatric surgery.

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