Bay State panel issues report on weight-loss surgeries

BOSTON – A state-run center focused on patient safety and medical-error prevention has issued freshing recommendations on weight loss surgery, noting that the number of such operations has increased rapidly while less-invasive surgeries have become the norm.

“Overwhelming new data highlighted in this report demonstrate reductions in known disease risk factors, improvements in health and significant reductions in mortality after weight-loss surgery,” John Auerbach, commissioner of the Mass. Department of Public Health, said in a statement. “We expect this report to continue to set the standard for improving the safety of weight loss surgery in the Commonwealth and beyond.”

Nationwide, the number of weight-loss operations climbed 800 percent – an eight-fold increase – between 1998 and 2004, the study found. Between 2005 and 2006, the number of such surgeries climbed another 11 percent, to more than 200,000 per year. The fastest growth has been among adults ages 55 to 64, who saw a 20-fold increase between 1998 and 2004.

In Massachusetts, the number of weight-loss operations climbed from 200 procedures in 1998 to 3,036 in 2004, an increase of nearly 152 percent. Between 2004 and 2006, it grew another 14 percent, to 3,447 – more than 17 times the 1998 level.

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Over the same period, the Betsy Lehman Center for Patient Safety and Medical Error Reduction’s Expert Panel on Weight Loss Surgery found, the type of surgery also has changed. It found a trend toward the use of combination procedures that not only restrict stomach size, as in laparoscopic banding, but also reroute part of the digestive tract, as in laparoscopic gastric bypass, the most commonly performed weight-loss surgery nationwide. And, it found, laparoscopy has displaced open surgery as the predominant approach.

Mortality from such surgeries has dropped sharply, from 0.89 percent in 1998 to 0.19 percent in 2004 – and to 0.07 percent in Massachusetts. Length of hospital stay also declined, shrinking 38.5 percent, from nearly 5 days in 1998 to 3.1 days in 2004. The oldest patients had both the longest hospital stays and the highest inpatient mortality rate.

The panel also mentioned the contributions of new accreditation and credentialing programs in weight-loss surgery; advances in anesthesiology; new patient transport and lift technologies; and new national credentialing standards in perioperative nursing.

On the patient side, the panel found that 99 percent of those who are eligible for weight-loss surgery never receive it, and said the need to accommodate the growing number of severely obese patients will require wide-ranging changes in new and existing health care facilities.

“We have an older, heavier population, and a rapidly-evolving surgical specialty,” said Dr. George L. Blackburn, of Beth Israel Deaconess Medical Center, chairman of the expert panel. “With up to one in 10 U.S. adults a potential candidate for weight-loss surgery, the need to protect the safety and well-being of patients who undergo these procedures is more critical than ever.”

A full copy of the report is available from the Betsy Lehman Center for Patient Safety and Medical Error Reduction by calling the center at (617) 624-5273 or visiting www.mass.gov/dph/betsylehman.

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