Medical Research Regarding Safety of WLS Surgery

MickeyDee
on 11/1/14 7:23 am

I get a newsletter from MedPage which had the following article regarding high safety rates for WLS surgery, including post-op complications:

"Gastric bypass surgery in patients with diabetes should be considered a safe procedure, analysis of outcomes from a large national database indicated.

Among 16,509 patients with diabetes who underwent laparoscopic Roux-en-Y gastric bypass surgery between 2007 and 2012, the composite 30-day complication rate was 3.4%, while the rate was 4.5% for those having laparoscopic appendectomy and 3.7% for patients having laparoscopic cholecystectomy, according to Philip Schauer, MD, and colleagues from the Cleveland Clinic.

Moreover, the mortality rate during the month after surgery was 0.3%, which was the same as for patients undergoing total knee arthroplasty, the researchers reported online inDiabetes, Obesity and Metabolism.

"While recent studies including five randomized controlled trials have shown the remarkable effects of bariatric surgery on type 2 diabetes with respect to glycemic control, cardiovascular risk factor modification, and possibly long-term complete remission of a progressive disease, the safety profile of metabolic/diabetes surgery has been a matter of concern among patients and physicians," they wrote.

To address those safety concerns, Schauer and colleagues examined data from the American College of Surgeons' National Surgical Quality Improvement Program, which gathers data on multiple variables and surgical outcomes from 374 U.S. sites.

The diabetes-gastric bypass group was compared with diabetic patients undergoing various other procedures such as coronary artery bypass graft (CABG), infrainguinal peripheral vascular revascularization, abdominal procedures such as partial colectomy, appendectomy, and hysterectomy, and knee replacement surgery.

Patients' mean age at the time of surgery was 50, and mean body mass index was 46.5 kg/m2.

The mean operative time was 138 minutes for gastric bypass, and length of hospital stay was 2.6 days.

Rates of serious complications and events within 30 days were transfusions in 1.22%, sepsis in 0.81%, pneumonia in 0.66%, deep venous thrombosis in 0.36%, pulmonary embolism and acute renal failure each in 0.22%, myocardial infarction in 0.16%, and stroke in 0.05%. Readmission within 30 days and reoperation occurred in 6.7% and 2.5%, respectively.

In comparison with the 3.4% composite complication rate seen with gastric bypass, the rate after CABG was 46.6%. The rate after infrainguinal bypass was 23.6%, while that seen following total knee arthroplasty was 16.7%.

Compared with the 30-day readmission rate of 6.7% with gastric bypass, the rate was 19.6% after infrainguinal bypass and 12.4% after CABG. In addition, compared with the 2.6 day length of stay with gastric bypass, hospitalization time was 7.9 days for CABG, 6 days for partial colectomy, and 3.6 for knee arthroplasty.

And mortality rates were 2.8% for CABG, 2.7% for infrainguinal bypass, and 1.8% for partial colectomy, compared with the 0.3% seen for gastric bypass.

"Findings of this study indicate that the 30-day mortality risk of [laparoscopic gastric bypass] (3 in 1,000) is one-tenth that of cardiovascular surgery, and earlier intervention with metabolic/diabetes surgery to treat diabetes and metabolic syndrome may eliminate the need for some later higher-risk procedures to treat cardiovascular complications of diabetes," Schauer and colleagues noted.

They also estimated that, based on data from the U.S. National Health Interview Survey, the 5-year cardiovascular mortality that could be attributed to diabetes would reach 11.4 out of 1,000, which is up to four times the short-term mortality associated with gastric bypass.

The study was limited by the inclusion of only laparoscopic Roux-en-Y gastric bypass and baseline differences between patients in the various comparison groups.

The authors disclosed no financial relationships.

 

 

 
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Primary source: Diabetes, Obesity and Metabolism
Source reference: Aminian A, et al "How safe is metabolic/diabetes surgery?" Diab Obesity Metab 2014; DOI: 10.1111/dom.12405.

 

I'd say this pretty well puts the "danger" warnings to bed.

swimbikerun
on 11/2/14 1:10 am
Thanks. I was surprised to see they didn't include a comparison to hip replacement, as the last article I saw said its that safe now.

Changing to a new blog. Please investigate your surgeon. Ask specific questions on after care, practice philosophies, office staff, nutrition, supplements, etc.

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