New Scoring System Predicts Gastric Bypass Surgery Risk article

New Scoring System Predicts Gastric Bypass Surgery Risk From Duke University Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=46347 Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Hey Jaim, The link leads to a page with many other links to different articles. Not clear which article is the one your reffering to...Sounds interesting though!! Enjoy the day, xoxo Your angelette

http://www.medicalnewstoday.com/medicalnews.php?newsid=46347 The link works for me, I see on above post it 'broke' so maybe try cutting entire link then pasting into browser? Jamie (make sure the newsid+46347 is in link, I see it may break again? Dunno why?

Here is the article: New Scoring System Predicts Gastric Bypass Surgery Risk 01 Jul 2006 Duke University Medical Center surgeons have developed a simple scoring system based on five patient characteristics that can predict which candidates for gastric bypass surgery would be at highest risk for dying. If validated by additional prospective studies, the new scoring system not only would give surgeons concrete information on which to base treatment options, but would help patients make informed decisions about potential risks, its developers said. Additionally, the system, if widely adopted, could provide a standardized way to compare outcomes among centers that perform the surgery. Gastric bypass surgery is used to help people who are morbidly obese lose weight. Although the surgery has several variants, the basic procedure involves stapling off a large portion of the stomach and reattaching the intestine to the smaller remaining portion. Because of their decreased stomach capacity, patients are unable to eat as much food and they feel sated much faster. Gastric bypass surgery is generally safe, according to the Duke researchers. But as with any type of surgery, there is a risk of adverse side effects or even death. The key, they said, is determining which patients are at the lowest risk. "Currently, there is no clinically useful system to help determine which patients would be at highest risk of dying after gastric bypass surgery," said Eric DeMaria, M.D., director of bariatric surgery at Duke, *****ported on the new scoring system June 29, 2006, at the annual meeting of the American Society for Bariatric Surgery in San Francisco. "We developed a scoring system that is based on five easy-to-identify patient characteristics that can help us decide whether or not a specific patient is a good candidate for surgery and what the probable risks would be," DeMaria said. "When talking to patients, we can cite national averages on risks, but that is not very helpful when I have a specific patient sitting in front of me. We needed a scientifically valid way for assessing individual risk." Roughly 170,000 Americans underwent gastric bypass surgery in 2005, according to the American Society for Bariatric Surgery. The society estimates that 15 million people, or 2 percent of the nation's population, are morbidly obese. To create their scoring system, the researchers retrospectively analyzed the outcomes of all 2,075 patients who underwent gastric bypass surgery between 1995 and 2004 at Virginia Commonwealth University, where DeMaria was a bariatric surgeon before coming to Duke in 2005. Both universities provided support for the current study. The researchers found that 31 of patients (1.5 percent) died within 90 days of surgery. In analyzing those who died, DeMaria and colleagues identified four factors that were independently predictive of increased risk: * A body mass index of greater than 50. This measure takes into account the relationship of weight and height; it is calculated by dividing weight in kilograms by height in meters squared. A range of 18.5 to 25 is considered normal. * Male gender. Men are more likely than women to suffer from conditions such as hypertension, diabetes and metabolic disorder, which can add to the risks of surgery. * Hypertension. Patients with hypertension typically have heart disease or chronic inflammation of blood vessels, which might add to the risks of surgery. * Pulmonary embolus risk. This variable measures whether patients have had a previous pulmonary embolism or are at risk for developing one. A pulmonary embolism is a blood clot that usually forms in a blood vessel deep in the thigh and travels up to the lung, where it can block blood flow to the lungs. * Increased age. In addition to the above four characteristics that were identified by the analysis of the 2,075 patients, the researchers added a fifth factor - age -- to their scoring system. Based on the results of past studies, patients over the age of 45 are known to be at the highest risk for death after bariatric surgery. "In using our system, each one of the five characteristics is worth one point," DeMaria explained. "Those patients with a score of zero are at the least risk, while those with five points are at the highest risk." The system deems patients with a score of zero or one to be low-risk. In the study, only three of the 957 patients in this group died, for a mortality rate of 0.31 percent. None of the 356 patients with zero points died. The medium-risk group, with a score of two or three points, had a mortality rate of 1.91 percent (19 deaths out of 999 patients). The high-risk group, with a score of four or five points, had a mortality rate of 7.56 percent (nine deaths out of 119 patients). "Many people see gastric bypass surgery as an option to use only when all other approaches to weight loss have failed," DeMaria said. "However, our system shows that this strategy may need to be reconsidered. If patients put off surgery while they attempt other therapies that ultimately don't work, over time they risk moving into a higher-risk category as they gain more weight, get older or develop hypertension. In these cases, delays can make surgery even riskier. "Our findings show that for the low-risk group of patients, gastric bypass surgery is a very safe option," DeMaria continued. "For those patients in the highest risk category, we should look at performing lower-risk or a number of smaller procedures to reduce the potential risk." ### Other members of the team were Dana Portenier from Duke and Luke Wolfe from VCU. Contact: Richard Merritt Duke University Medical Center

HA! very interesting, by this test i scored a zero! I've never been so thrilled to score so low in my whole academic life.

jamie, this was really informative.thanks lots...sue

One interesting point struck me - and it's the one stating "delays in surgery". Many of us are subject to insurance approval denials, delays etc... Which leads me to conclude that In essence, our "HMO's, PPO's and others, can increase our risk factor much higher than necessary (in general). Some of us, have to wait up to 6 months while we a nutritionist, before applying for approval. If a person is super obese - this can pose a huge threat - as during this waiting period, the incumbent can develop other co-morbities. Well, I'm glad I was able to read this article (thx Jamie). \(^_^)/ susie

Susie: Yes there are waits for surgery, finding the balance between NECESSARRY and HELPFUL waits (meaning the time is prudently/wisely spend by BOTH the providers and patients) vs UNNECESSARY & HARMFUL waits can pose challenging and determining which is not as easy as one would think.... For instance..I truly believe to be successful LONGTERM one needs to first be able to GET OFF THE TABLE, no one should have WLS if they do not have that chance. So careful INDIVIDUAL clearances should be performed (this will depend on comorbidities and family hx but may include cardiology/endocrinology/hematology/pulmonology/psychiatry/gastroenterology/nutrition/primary care etc). Getting an individual into the safest shape to survive/being a reasonable risk/candidate. Second they should be VERY well educated and informed not only on the potential benefits and risks/complications but on the true EFFORT needed on their part to CHANGE their life, w/o that INADEQUATE LOSS AND REGAIN AND HEALTH ISSUES (MALNUTRITION) ARE most likely and one will then be trading one deadly disease (Morbid Obesity, for another just as deadly: MALNUTRITION). This can take considerable time. I truly think ~6 months is a good minimum length of time to think/consider/research, so people can make a non-impulsive decision they can live with forever. Many of us have been researching for years and it truly can take this time to be MENTALLY prepared which I think is equally as important as physically prepared. If many people go into this surgery unprepared, die or are unsuccessful, that will only perpetuate a negative view of WLS in the community and can heavily and adversely effect the future of making this a non option as insurance companies maynot pay saying it is not successful etc. (*Oh so much to consider!), malpractice goes up if surgeons have more complications/mortalities as well which can drive surgeons out of bariatrics etc. All decreasing access. Although I realizze no one can know everything about WLS many go into this thinking it is a quick fix and that they willnever have to 'diet' again and sadly find out different once the honeymoon is over 6-12, 18 months down the road and WLS just becomes another failed diet attempt sadly for MANY! So I partially agree with insurance companies making people go on a 6 mo medically supervised 'diet' this can be viewed as a hoop or a opportunity to work on the habits one will need to change with WLS as WLS itself will not make ANYONE change anything...Using that time to research, learn, network with others, get other clearances, all while attempoting to cut poortions, get into a mental frame to do what will be needed, smaller portions, exercise as tolerated, being accountable...It also prevents the oh I saw so and so had their stomach stapled and lost wt I think I will do that, they get surgery and do notrealize what it is all about, I know many bariatric centers attempt to be multidisciplinary and the centers of excellence will drive this as well, So many times I hear people say 1-2, 3 yrs out, "If I had only known this that BEFORE". My process took about 6 months from research to 1st MD apt w/ clinical nutrition, to losing my required 10% (I am so thankful for this, it allowed me to reach a normal BMI and gave me a head start on the head issues as well!) my gall bladder US, labs, H&P, psych clearace, Upper GI test and surgeon appointments (went to 2)....my support groups (weekly for 6mo preop helped me learn more than anything I got online etc!)........ SO some waits can not be avoided, if used wisely can actually help people be successful I believe..But thats just my opinion! We all have one! And if it took me 3 yrs to make the decision to be as ready as I needed to I guess that is best, again we are all individuals w/ individual needs.... Take Care, Jamie Ellis RN MS NPP Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"