Bariatric Surgery Safety Report
By Collin E. M. Brathwaite, MD FASMBS
Bariatric surgery can sometimes be an uncomfortable topic when primary care providers speak with their patients about weight loss--but it should not. Bariatric surgery is safe, effective and is lifesaving for the patients who are part of a comprehensive and accredited program that is overseen by the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
Patients who undergo weight loss surgery are often relieved of chronic associated medical conditions that have been plaguing patients for years and have threatened to worsen over time. These include chronic kidney damage leading to patients requiring dialysis, hypertension that develops into congestive heart failure and diabetes worsening to amputation of toes and parts of the feet. Since studies show that most people with type 2 diabetes mellitus will die of a complication of the diabetes, it is well worth considering. All of these chronic conditions can be improved or corrected with reduction in weight before the extensive damage is done and the patient can go on to live a longer, healthier life.
The Journal of American Medical Association (JAMA) published an excellent study that reviewed the literature from 2003-2012 and it found that the average reduction in body mass index (BMI) was from a BMI of 46 to between 29 and 34 depending on procedure and compliance with postoperative dietary and lifestyle requirements. Normal BMI is 19 to 25. It revealed that the average return to emergency room rate was 10-17% for non- emergent issues including dehydration, nausea/vomiting, bleeding, reflux, GI symptoms, band erosion/slip, and nutrition/electrolyte irregularities. The average national leak rate was <2%, not always requiring a return to the operating room. The reoperation rate nationally averaged 7%, this could be for any reason, including hernia, leak, bleed, or other. Mortality rate within the first 30 days after surgery was 0.08% and after 30 days rose to 0.3%. That is less than the mortality rate of a gallbladder removal.
Weight loss surgery is a viable and safe method that should be offered to patients who have a BMI >35+ with severe comorbid conditions such as hypertension, gastroesophagel reflux disease, sleep apnea and diabetes. It is also an option for patients with BMI’s greater than 40 with no associated medical conditions as well.
Most insurance carriers do cover bariatric surgery and most accredited programs do offer informational seminars so that the patients can learn more on their own. Encouraging prospective patients to learn more is always a good idea so they can see if this is an option they might be interested in to improve their health.