Studies show that the number of bariatric surgeries being performed in the U.S. continues to increase. However, these procedures’ quality and safety vary widely from one hospital to another. HealthGrades, a Golden, Colorado-based, independent healthcare ratings organization, has released the findings of its fifth annual study of bariatric surgery. For this recent study, more than 190,000 patients who had undergone bariatric surgery from 2006-2008 were involved. These patients had been discharged from 684 hospitals in 19 states.

Surgical Complications Falling Nationwide
For the purposes of the study, the researchers assigned hospitals one of three ratings, indicating “best-performing,” “average-performing” and “poor-performing” facilities. And the good news? The ratings showed that the overall rates of risk-adjusted, in-hospital complications and mortality related to obesity surgery are decreasing!

Specifically, the researchers found that those patients at top hospitals experienced a 66.55% lower chance of experiencing complications than those patients who underwent bariatric surgery at a bottom-ranked hospital. In addition, the patients at top hospitals reported shorter lengths of stay. The researchers concluded that if all bariatric patients had surgery at levels similar to top-ranked hospitals, 5,046 patients could avoid major in-hospital complications during this three-year period.

Which Facility You Choose Plays A Large Part
But there is some bad news - The researchers did observe that there were large performance gaps among the different facilities. As an example, bariatric surgery mortality, which is rare, was found to occur four times more at bottom-performing hospitals than top-performing hospitals.

“Bariatric surgery has been proven to reduce caloric intake and control obesity, but the HealthGrades study demonstrates that where patients have this type of surgery matters-a great deal,” said Rick May, HealthGrades’ vice president of clinical consulting. “There is a subset of U.S. hospitals whose patients, the data show, have fewer complications and leave the hospital earlier.”

Source: Modernhealthcare.com/article/20100526/NEWS/305259974

Greek researchers found that repeated bariatric weight loss surgeries may result in higher risks of complications than undergoing one procedure. These procedures have been shown to be the only effective method for long-term weight loss in severely obese people.

The study’s findings, which were published in the journal Archives of Surgery, focused on 56 patients who had repeat bariatric surgery between 1995 and 2008. The patients’ average age was 39.6, while the average body mass index (BMI), the measurement of weight and height, was 46.9. A BMI score of more than 30 is considered “obese.”

The Potential Risks of Multiple Bariatric Procedures
The results showed that the rates of patients having multiple (or “revisional”) bariatric surgery range from 5-56%. In the study, the patients were followed-up for an average of 102 months after their revisional surgery. It was found that while no patient died, 19 (33.9%) experienced serious complications within 1-3 months after surgery, including: internal leakage from the surgical site, acute kidney failure and pneumonia. As for late complications, which occur more than 90 days after surgery, these were reported in 13 patients (23.2%). These complications included: hernia at the incision site and narrowing of the passageway between the stomach and intestine.

For the study, 39 patients underwent revisional surgery due to inadequate weight loss after their initial procedure. These patients achieved a significant decline in BMI, declining from an average of 55.4 to 35; this represents an average loss of nearly 69% of excess body weight. In addition, these revisional procedures imparted benefits for those experiencing nutritional complications and intolerable side effects after their initial procedure. Patients are classified as having revisional bariatric surgeries for three reasons:

1. Unsatisfactory weight loss after the initial procedure
2. Severe nutritional complications such as protein malnutrition, and
3. Intolerable side effects such as blocking or narrowing of the digestive tract.

The study’s authors believe that as these procedures are continually improved, and their benefits for weight loss are publicized, revisional surgeries may become more common.

Researchers at Monash University and the Royal Children’s Hospital in Melbourne show that one specific procedure — lap-band surgery — may lead to a loss of up to 80% of excess fat in patients!  In fact, the surgery’s outcomes, which were published in the Journal of the American Medical Association, were shown to be much more effective for adolescents than just following severe dieting and exercise programs.

The Lap-Band Vs. “Lifestyle” Changes
For the government-funded study, the researchers observed 50 severely obese teens between the ages of 14 and 18 from May 2005 to September 2008. Half of the patients underwent gastric banding surgery, in which a silicon clamp is implanted that shrinks the stomach and reduces appetite. These patients were told to eat only three small meals and exercise for 30 minutes each day. Meanwhile, the other 25 patients remained on a strictly supervised diet and exercise regime.

It was found that those receiving the surgery lost an average of 77 pounds, which was more than 10 times the weight of the other group. Overall, after two years, those teens undergoing surgery lost an average of 79% of their excess weight, while those following just the lifestyle changes lost just 13%. It should be mentioned that six of the lifestyle group withdrew from the study after gaining weight, even though they had access to a personal trainer, physician, dietician and regular guidance.

Weight Loss Benefits, But NOT A “Quick Fix”
The bottom line? Lap-band weight loss surgery may offer remarkable benefits for weight loss for teenage patients. “While this study confirms that some adolescents can achieve substantial weight loss and health improvements through diet and exercise, gastric banding should be considered for those severely obese adolescents who find primary weight loss methods unsuccessful,” stated study author Professor Paul O’Brien.

However, healthcare professionals caution that this and other procedures are not a “quick-fix” solution for weight loss, especially for younger patients.

The Benefits Outweigh the Risks
According to ground-breaking findings conducted by University of Cincinnati researchers, bariatric procedures may actually improve the well-being — and even extend the lives — of the five percent of the American population faced with the highest measures of obesity. Essentially, the study, which was published in Archives of Surgery, found that weight loss surgery’s benefits far outweigh the risks of being morbidly obese. The label “morbid obesity” refers to those having a body mass index (BMI) of 40 or more.

Up until now, potential surgical patients have had to take into account such factors as age. But a new program is being developed that should enable both patients and medical professionals weigh the “pro’s” and con’s” of surgery.
“In the future, we plan on having a Web-based decision support tool,” stated Dr. Daniel P. Schauer, assistant professor of internal medicine at the University of Cincinnati Academic Health Center. “Hopefully, it will be available some time in the next year. It is in the development and testing phase.”

Life Expectancies May Be Boosted
For this study, the researchers focused on more than 23,000 post-surgical patients. The study was designed to contrast prospective patients’ immediate risk of death due to surgery and the possible years of life expectancy due to undergoing these procedures. Schauer and his colleagues determined that after undergoing gastric bypass surgery, one of the most popular types, a 42-year-old woman with a BMI of 45 would gain three years of life expectancy. Meanwhile, a 44-year-old man with the same BMI would gain 2.6 years of life.

The study also showed that the 30-day mortality related to the surgery varies among populations.  “The patients who benefit the most are younger patients who have a lower risk of dying from the surgery and a higher BMI,” said Schauer said. “The patients who benefit the least are older patients with a higher surgical risk because of a combination of age and comorbidities [other illnesses].” It should be mentioned that these findings don’t take into account risks related to coronary disease and other conditions. However, this is being incorporated in the next round of studies.

Good News for Healthcare Practitioners?
These findings are making healthcare professionals very happy, especially in relation to improvements in both costs/savings and health and well-being. Research shows that one diabetic costs the healthcare system about $13,000 annually. But weight loss surgery has been found to have impressive benefits for reducing and even eliminating diabetes.

In another study conducted by researchers at the University of California at Irvine, it was shown that the U.S. Government’s approval of Medicare and Medicaid payment in 2006 for these procedures has had a big effect, as well. To qualify for coverage, patients must have their procedure at a medical center certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery. Additionally, these facilities must perform at least 125 operations a year.

For this study, the researchers examined the outcomes of almost 3,200 operations done just before the Government’s approval and almost 3,100 done just after approval. They found that there was a shift to patients having their procedures at certified, high-volume centers. In addition, it was shown that hose having surgery after government approval had shorter hospital stays (3.5 days vs. 3.1 days) and lower rates of complications (12.2 percent vs. 10 percent). No significant difference was seen in the in-hospital mortality rate (0.28 percent vs. 0.2 percent).

Source:

http://news.yahoo.com/s/hsn/20100119/hl_hsn/forveryobesegastricbypassmayextendlife

In a study published in the Journal of the American College of Surgeons, New York University researchers focused on about 50 girls and boys ages 14-17. The findings of the study revealed that the subjects demonstrated significant decreases in both total and “android fat” mass 2 years after surgery. “Android fat,” or abdominal obesity, has been associated with the development of obesity-related illnesses, including diabetes, heart disease, and insulin resistance.

Benefits for Weight Loss & Overall health
The researchers found that undergoing Lap band surgery effectively improved glucose metabolism. In turn, this then reduced the teenage subjects’ risks for developing insulin resistance. The researchers also found that as the surgery had no impact on bone mineral density, bone growth was not affected.

“This study is the first to demonstrate the improvements in overall health and distribution of weight loss after Lap band surgery in adolescents,” said Evan Nadler, MD, the lead author. “While weight-loss surgery should always be a last resort for adults and adolescents, these findings show us that surgery in adolescents reduces the risk of significant health complications.”

SOURCE: Laparoscopic Adjustable Gastric Banding for Morbidly Obese Adolescents Affects Android Fat Loss, Resolution of Comorbidities, and Improved Metabolic Status. Journal of the American College of Surgeons, 2009; 209 (5): 638 DOI: 10.1016/j.jamcollsurg.2009.07.022

It’s true! A new study published in the journal CHEST suggests that for male and female asthmatics, being obese may cause poorer asthma control than if you’re of normal weight. The study’s findings indicate that these obese asthmatics may carry a specific trait causing the poorer control. They may experience different asthmatic properties than non-obese people, as well.

In the study, Canadian researchers compared 44 obese subjects with asthma and 44 non-obese subjects with asthma. The subjects were examined for various medical categories, including:

• pulmonary function changes
• methacholine challenge scores – “methacholine” is a chemical compound shown to diagnose bronchial “hyperresponsiveness,” the contracting of the lungs’ small airways
• sputum induction cell counts – “sputum” is fluid released orally
• symptom perceptions
• BMI/waist circumference
• waist-to-hip ratio

The study’s findings found that the obese subjects displayed poorer asthma control than the non-obese. In addition, the obese subjects had lower measures of total lung capacity, expiratory reserve volume, functional residual capacity, and residual volume.

Researchers have found that undergoing bariatric surgery may effectively eliminate ALL signs of type 2 diabetes. Bariatric surgery’s benefit for type 2 diabetes mellitus was the subject of a study recently published in The American Journal of Medicine. The meta-analysis, comprised of 621 studies from 1990-2006, showed that 78.1% of diabetic patients experienced complete resolution. In addition, the 86.6% of the patients’ diabetes improved or was resolved after undergoing bariatric surgery. Type 2 diabetes mellitus has been found to be directly influenced by obesity. The primary risk factor for this disease is obesity, and 90% of all patients are overweight or obese.

Understanding the Surgical Procedures’ Findings
The involved studies were far-reaching, and involved 135,246 patients.  Of these, 3188 patients experienced resolution of both the clinical and laboratory manifestations of type 2 diabetes. 11,175 patients reported both weight loss and diabetes resolution; these were completely separate from the 4,070 diabetic patients involved in those studies.

    These patients were categorized by the surgical method they underwent: laparoscopic adjustable gastric banding, gastroplasty, gastric bypass, and biliopancreatic diversion/duodenal switch (BPD/DS). The results were as follows: gastric banding (56.7% resolution); gastroplasty (79.7%); gastric bypass (80.3%); and BPD/DS (95.1%).
    Two years later, the resolutions were as follows: gastric banding (58.3% resolution); gastroplasty (77.5%); gastric bypass (70.9%); and BPD/DS (95.9%).
    As for the percent excess weight loss, the resolutions were: laparoscopic adjustable gastric banding (46.2%); gastroplasty (55.5%); gastric bypass (59.7%); and BPD/DS (63.6%).

“This systematic review and meta-analysis demonstrate that bariatric surgery has a powerful treatment effect in morbidly obese persons with type 2 diabetes; 82% of patients had resolution of the clinical and laboratory manifestations of diabetes in the first 2 years after surgery, and 62% remained free of diabetes more than 2 years after surgery (80% and 75% for the total group),” states Henry Buchwald, MD, PhD, Department of Surgery, University of Minnesota. “Randomized clinical trials comparing surgery and medical therapies for type 2 diabetes are urgently needed. Considering the potential benefits for millions of people, such trials should assess the risk/benefit ratio of surgery in less obese (BMI 30-35 kg/m2) populations, as well as in the morbidly obese (BMI>35 kg/m2) population.”
http://www.medicalnewstoday.com/articles/141314.php