Rushed Discharge After Weight-Loss Surgery May Raise Risks (HealthDay)

WEDNESDAY, June 15 (HealthDay News) -- Weight loss surgery patients who are discharged from the hospital too soon after undergoing gastric bypass have an increased risk of complications and death, a new study has found.

After analyzing data from nearly 52,000 gastric bypass patients, researchers found that those released from the hospital the day of surgery were 12 times more likely to have serious complications (1.9 percent versus 0.16 percent) and 13 times more likely to die than patients who left the hospital after the U.S. average of a two-day stay.

The death rate within 30 days of discharge was 0.1 percent for those who stayed in the hospital for two or more days, versus 0.8 percent for those who left the day of surgery.

Patients who were discharged from the hospital less than 24 hours after an overnight stay were two times more likely to die within 30 days than those who remained in hospital for two days after their surgery, the investigators found.

Like all surgeries, bariatric surgery carries surgical risks, including serious infections, internal bleeding, blood clots, and death, according to the American Society for Metabolic & Bariatric Surgery (ASMBA).

Length of stay appeared to be a greater risk factor than age, gender, race, body mass index and obesity-related conditions, the researchers noted.

The study was scheduled for presentation Wednesday at the annual meeting of the American Society for Metabolic & Bariatric Surgery, in Orlando, Fla. Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"This study shows what a difference a day makes," co-author Dr. John Morton, an associate professor of surgery and director of bariatric surgery at Stanford Hospital & Clinics at Stanford University, said in an ASMBS news release.

"A two-day length of stay appears reasonable for most people and results in a safety profile that rivals gallbladder or hip replacement surgery. To reduce it further may put patients at an increased chance of unnecessary risk," said Morton, who is chair of the ASMBS Access to Care Committee. "A patient should be discharged based on his or her individual risk profile. We counsel our patients to avoid drive-thru fast food, and also advise against drive-thru gastric bypass."

"Bariatric surgery is safer than ever, but discharging patients too soon after surgery may be pushing the envelope too far and may have serious consequences," he added.

More information

The U.S. National Library of Medicine has more about gastric bypass surgery.

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Older men don't live longer with weight-loss surgery (Reuters)

NEW YORK (Reuters Health) – Weight-loss surgery may not help obese middle aged and older men live longer, according to new research that runs counter to earlier findings in younger people.

The results mean doctors should be extra careful when counseling obese patients about their treatment options, Matthew Maciejewski of Durham VA Medical Center in North Carolina and colleagues write in the Journal of the American Medical Association.

In 2009, more than 220,000 Americans had some type of weight loss surgery, at a price of about $20,000 per patient, according to the American Society for Metabolic and Bariatric Surgery.

Experts say surgery is the most enduring way to bring down one's weight, and earlier studies have suggested it will increase life expectancy by up to three years.

At first, the new study did appear to confirm those findings, but the benefit didn't hold up when comparing similar patients who did or did not have surgery.

The researchers looked back at the outcomes of 850 veterans, mostly men over 50 years old, who'd had weight-loss surgery between 2000 and 2006.

Six years after their surgery, about seven percent of the men had died, compared to 15 percent among a comparison group of obese men who didn't have surgery.

But when patients from the two groups were matched closely according to weight, age, race and other factors, the survival gap disappeared.

Previous studies have found that about seven percent of patients having weight-loss surgery experience complications, although most are minor wound problems.

Serious complications -- such as massive bleeding or kidney failure -- occurred in 2.6 percent of patients in one study from last year.

The new study is the first to compare death rates among heavy middle aged and older men who did or did not have weight-loss surgery, the researchers say, but it did have a number of limitations.

For instance, it's possible that following the patients for longer than six years would have changed the picture in favor of those who had surgery. And, the researchers stress, patients may still want surgery, even if it turns out not to affect their life expectancy, because the weight loss is likely to improve other medical conditions and quality of life.

SOURCE: http://bit.ly/ifujZX Journal of the American Medical Association, online June 12, 2011.

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Study Reveals Bariatric Surgery Less Effective in Middle-Aged Adults (ContributorNetwork)

If you're morbidly obese and middle-aged, weight-loss surgery may not decrease your chances of dying, according to a study published Sunday in the online Journal of the American Medical Association. Morbidly obese is defined as having a body mass index greater than 39 and generally means someone who is 100 pounds or more overweight.

Researchers were interested in studying the mortality rates of middle-aged and older adults after bariatric surgery. Data available prior to this study was based almost solely on young, white females who had had the weight-loss surgery. That group of individuals has a lower incidence of mortality related to obesity even before bariatric surgery than do older adults, according to study researchers.

The purpose of the study was to determine the effectiveness of weight-loss surgery in populations with an increased risk of death related to obesity; these populations were identified as being highest in men and minority populations.

The research team studied follow-up data for 850 men with a mean age of 49.5 years and a mean BMI of 47.4 for an average of 6.2 years. The men in the study had the weight-loss surgery between the years 2000 and 2006. Their mortality (death) rate was compared to a control group of 41,000 other men who did not have the surgery, reports Yahoo! News. All the men were patients at medical centers of Veterans Affairs.

Researchers concluded that bariatric surgery in morbidly obese middle-aged men did not decrease their risk of death compared with care that did not include the surgery. Still, this population may opt for weight-loss surgery based on factors other than mortality rate, such as the reduction of body weight, control of obesity-related health conditions and improved quality of life.

In the United States, weight-loss surgery usually involves one of four procedures, explains the Weight-Control Information Network. The four procedures, each with its own risks and benefits, are: adjustable gastric band (AGB); Roux-en-Y gastric bypass (RYGB); biliopancreatic diversion with a duodenal switch (BPD-DS); and vertical sleeve gastrectomy (VSG). The AGB works by decreasing food intake while the other surgeries involve not only the decreased ability to take in food but also affect food absorption and other factors.

Your physician will weigh conditions such as your health, obesity-related health conditions and your eating behaviors in helping to determine which, if any, of the weight-loss surgeries would be to your benefit. The outcome of this new study into mortality rates following bariatric surgery may be a factor in your consideration of the procedure now also.

Smack dab in the middle of the baby boomer generation, L.L. Woodard is a proud resident of "The Red Man" state. With what he hopes is an everyman's view of life's concerns both in his state and throughout the nation, Woodard presents facts and opinions based on common-sense solutions.

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Weight-Loss Surgery May Not Lower Death Risk: Study (HealthDay)

SUNDAY, June 12 (HealthDay News) -- Weight-loss surgery doesn't decrease the risk of death among severely obese middle-aged adults, a new study says.

U.S. researchers looked at 850 male patients at Veterans Affairs medical centers who had weight-loss (bariatric) surgery between January 2000 and December 2006. Their average age was 49.5 and their average body mass index was 47.4 (a body mass index, or BMI, over 40 is considered severely obese).

The death rate in this group of patients was compared to that of a control group of about 41,000 VA patients (average age 54.7, average BMI 42) who didn't have surgery.

Eleven of the 850 bariatric surgery patients (1.29 percent) died within one month after surgery. Unadjusted analysis of the death rates over a six-year period showed that the bariatric surgery patients had lower death rates than those in the control group, but further analysis showed that bariatric surgery was not significantly associated with reduced risk of death, said Matthew L. Maciejewski, of the Durham VA Medical Center in Durham, N.C., and colleagues.

The study, published online and in the June 15 print issue of the Journal of the American Medical Association, was to be presented Sunday at an AcademyHealth research meeting in Seattle.

Even though bariatric surgery doesn't reduce the risk of death among middle-aged male patients, many of them still decide to undergo the procedure because there's strong evidence that it reduces body weight and obesity-related health problems, and improves quality of life, the researchers said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about bariatric surgery.

View the original article here

Weight-Loss Surgery May Not Lower Death Risk: Study (HealthDay)

SUNDAY, June 12 (HealthDay News) -- Weight-loss surgery doesn't decrease the risk of death among severely obese middle-aged adults, a new study says.

U.S. researchers looked at 850 male patients at Veterans Affairs medical centers who had weight-loss (bariatric) surgery between January 2000 and December 2006. Their average age was 49.5 and their average body mass index was 47.4 (a body mass index, or BMI, over 40 is considered severely obese).

The death rate in this group of patients was compared to that of a control group of about 41,000 VA patients (average age 54.7, average BMI 42) who didn't have surgery.

Eleven of the 850 bariatric surgery patients (1.29 percent) died within one month after surgery. Unadjusted analysis of the death rates over a six-year period showed that the bariatric surgery patients had lower death rates than those in the control group, but further analysis showed that bariatric surgery was not significantly associated with reduced risk of death, said Matthew L. Maciejewski, of the Durham VA Medical Center in Durham, N.C., and colleagues.

The study, published online and in the June 15 print issue of the Journal of the American Medical Association, was to be presented Sunday at an AcademyHealth research meeting in Seattle.

Even though bariatric surgery doesn't reduce the risk of death among middle-aged male patients, many of them still decide to undergo the procedure because there's strong evidence that it reduces body weight and obesity-related health problems, and improves quality of life, the researchers said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about bariatric surgery.

View the original article here

Obese People at Higher Risk of Infection After Colon Surgery (HealthDay)

TUESDAY, May 17 (HealthDay News) -- Obese patients are at a significantly increased risk for surgical site infections after undergoing partial or full removal of the colon, a new study finds.

It included 7,020 patients, aged 18 to 64, who had either partial or total colectomy for colon cancer, diverticulitis or inflammatory bowel disease between 2002 and 2008. Of those patients, 1,243 were obese.

The overall rate of surgical site infections was 10.3 percent, but the rate was higher in obese patients (14.5 percent) than in non-obese patients (9.5 percent). After adjusting for a number of factors, the researchers calculated that obese patients were 60 percent more likely to develop surgical site infections than non-obese patients.

The average cost of colectomy for all the patients was $16,399, but the average cost for obese patients was about $295 more than for non-obese patients.

The researchers also found that surgical site infections greatly increased the cost of the procedure. The average total cost for patients who developed surgical site infections was $31,933, compared to $14,608 for patients without infection.

Patients with surgical site infections also had longer average hospital stays (9.5 days vs. 8.1 days) and a much higher rate of hospital readmission (27.8 percent vs. 6.8 percent).

"We conclude that patients undergoing colorectal surgery who develop SSIs [surgical site infections], many of whom are obese, tax the health-care system," wrote Dr. Elizabeth C. Wick, of the Johns Hopkins School of Medicine in Baltimore, and colleagues.

Incentive programs that reward surgeons for keeping costs down and improving patient outcomes should take into account that obese people are at higher risk of infection, according to the authors.

The study appears in the May issue of the Archives of Surgery.

More information

The University of Chicago Medical Center has more about colectomy.

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Weight-Loss Surgery Linked to Rise in Fracture Risk (HealthDay)

SATURDAY, June 4 (HealthDay News) -- The risk of fractures after weight-loss surgery may be even higher than previously thought, a new study suggests.

Prior research has shown that people who undergo surgery to lose weight, such as gastric bypass, have an increased risk for bone fractures. One study, for example, showed a 1.8-fold increased risk of fracture compared to the general population.

But further analysis showed the risk was actually closer to 2.3 times greater, according to the study to be presented Saturday at the Endocrine's Society's annual meeting in Boston.

Researchers noted the odds of breaking the feet or hands are even higher -- about three times higher than normal.

"A negative effect on bone health that may increase the risk of fractures is an important consideration for people considering bariatric surgery and those who have undergone bariatric surgery," said study author Kelly Nakamura, medical student at Mayo Clinic College of Medicine in Rochester, Minn., in a news release.

In following 258 patients who had bariatric surgery, researchers found that 79 of them had 132 fractures over the course of nine years. On average, the first break happened about six years after surgery. The study noted patients who got more physical activity before surgery had a lower risk of fracture than those who were more sedentary.

The study's authors pointed out the increased risk of bone fracture does not necessarily coincide with a greater risk for developing osteoporosis, the age-related bone-thinning disease.

As a result, they said, drugs used to treat osteoporosis may not be appropriate for these patients. The researchers concluded additional studies are needed to not only explain the link between weight loss surgery and fractures but also to determine the best way to prevent these breaks from happening in the first place.

"Clinicians may need to consider measures to optimize bone health and reduce fracture risk after bariatric surgery, such as fall prevention and optimizing calcium and vitamin D nutrition," said the study's principal investigator, Dr. Kurt Kennel, assistant professor of medicine in the endocrinology division at Mayo Clinic, in the news release.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Society for Metabolic and Bariatric Surgery has more information on the benefits of bariatric surgery.

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Weight-Loss Surgery May Lower Risk of Alzheimer's in Diabetics (HealthDay)

SUNDAY, June 5 (HealthDay News) -- While the finding isn't conclusive, a new study suggests that weight-loss surgery in obese diabetics could lower their risk of developing Alzheimer's disease.

Researchers found that gastric bypass patients, when tested six months after their weight-loss surgeries, had less expression of genes that are thought to be precursors of the debris that clogs the brains of people with Alzheimer's disease.

"Our study shows for the first time that weight loss resulting from bariatric surgery leads to a reduction in the expression of genes related to Alzheimer's disease," study author Dr. Paresh Dandona, a professor at State University of New York at Buffalo, said in a news release from the Endocrine Society.

The study was scheduled to be presented Sunday at the society's annual meeting in Boston. Research presented at meetings should be viewed as preliminary because it has not been subjected to the same level of scrutiny as studies published in most medical journals.

In the study, the researchers analyzed the blood of 15 patients with type 2 diabetes who underwent weight-loss surgery and lost an average of about 86 pounds over six months. Compared to before the surgery, the patients' expression of amyloid precursor protein fell by 22 percent, and the researchers also noticed less expression of other genes that appear to be connected to Alzheimer's disease.

However, the study didn't examine the patients for signs of the disease, so there's no way to know if their risk actually went down.

Scientists think there's a link between obesity and diabetes, which appears to boost the risk of Alzheimer's disease, said Greg Cole, associate director of the Alzheimer's Center at the University of California, Los Angeles. He said obesity may boost inflammation in both the body and the brain.

"Weight loss is likely to improve health, but one caveat is that the epidemiology of weight loss is complicated," he added. "Weight loss in elderly people can be a harbinger of incipient dementia. Further, according to a National Institute on Aging study, there may be significant differences in the way in which changes in mid-life weight impact the risk for Alzheimer's: women who lose weight between 30 and 45 actually appear to be at increased risk."

More information

For more about Alzheimer's disease, visit the U.S. National Library of Medicine.

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