For those considering bariatric surgery to combat significant obesity, a new study suggests the risk of complications may be much lower than what has previously been reported.
The study, which looked at both gastric bypass surgery and laparoscopic adjustable gastric banding (lap-band surgery), found that the risk of death for these surgeries was 0.3 percent and the risk of a major adverse outcome was 4.3 percent.
"Bariatric surgery is safe," said study co-author Dr. Bruce Wolfe, a professor of surgery at Oregon Health & Science University in Portland. "Certain factors [such as a history of blood clots, obstructive sleep apnea or impaired functional status] increase the risk of complications, but you can discuss these risks as well as the potential benefits with your surgeon."
Results of the study appear in the July 30 issue of the New England Journal of Medicine.
As obesity rates have risen, so, too, has the popularity of bariatric surgery. Although it is a major surgical procedure, the benefits to the severely obese generally far outweigh the risks. In fact, the risk of death over time is about 35 percent lower for someone who's had the surgery compared to someone who remains extremely obese, according to background information in the study.
However, the surgery isn't for everyone. "If you're five or 10 pounds overweight, bariatric surgery isn't for you," said Dr. Malcolm K. Robinson, an assistant professor of surgery at Harvard Medical School, and the author of an accompanying editorial in the same issue of the journal.
"Basically, when I or my colleagues advise surgery, it's because the benefits of surgery outweigh the risks. In general, that's the case for someone with a BMI [body-mass index] of 35 and weight-related health problems like diabetes or high blood pressure, or someone with a BMI of 40 or more," said Robinson, who added that as the risks of the surgery keep dropping, those BMI numbers may get even lower in the future.
The current study included 4,776 people who underwent one of the following types of bariatric surgery: lap-band surgery (1,198 patients), laparoscopic gastric bypass (2,975 patients), open gastric bypass (437 patients) or another procedure (166 patients). All of the surgeries were done by surgeons specifically qualified for this study. All of the surgeries took place between March 2005 and December 2007.
The average age of the study participant was 44.5 years old, 22 percent of the study volunteers were male and 11 percent were nonwhite. The average BMI in the study was 46.5. More than half of the study group had at least two coexisting medical conditions, the study authors noted.
In his editorial, Robinson points out that these procedures may represent "best-case scenarios" because they were done by experienced surgeons in high-volume bariatric centers. However, he said that because the field of bariatric surgery has advanced so much in the past few years, he believes these results are a "generally achievable phenomenon."
Both Robinson and Wolfe recommend that any person considering bariatric surgery should choose a facility that's been designated as a "Center of Excellence" because that means that the surgeon and the whole health-care team are qualified and experienced.