The 30-day mortality for bariatric surgery was 0.4% when the procedure was done at academic medical centers with a high volume of this surgery, reported Dr. Ninh T. Nguyen, chief of the GI surgery division at the University of California, Irvine, and his associates.
Some researchers and clinicians became concerned about high perioperative mortality when a recent study in Washington state reported a 1.9% 30-day mortality for bariatric surgery, and a national study involving over 16,000 Medicare patients reported a 2% 30-day mortality, Dr. Nguyen and his associates said.
They evaluated the perioperative outcomes of 1,144 bariatric surgeries performed at facilities affiliated with a university health system. A total of 29 of the 93 member academic medical centers participated; each facility provided the medical records of about 40 consecutive bariatric surgeries performed between October 2003 and March 2004.
Most of these medical centers performed a high volume of bariatric procedures. The analysis was restricted to routine or elective procedures in patients with a body mass index (kg/m
The findings of this study may not reflect outcomes in nonacademic medical centers or hospitals that perform a lower volume of bariatric procedures. The results also may not be generalizable to emergency or open procedures or to patients who are male, nonwhite, or less affluent or who have a BMI less than 35 or greater than 70, the investigators noted (Arch. Surg. 2006;141:445–50).
The 30-day mortality in these 1,144 cases was 0.4%, and the in-hospital mortality was 0.2%. Causes of death were multiple system failure (three patients) and pulmonary embolism (one patient). These results show that bariatric surgery performed at academic medical centers is safe, with low perioperative mortality, Dr. Nguyen and his associates said.
The 30-day readmission rate was 6.6%. Readmissions were needed for dehydration and vomiting, as well as other complications. The complication rate was 16% and included cases of anastomotic leakage (1.6%), wound infection (2.6%), pneumonia (1.9%), cardiac arrhythmia (1.7%), bowel obstruction (1.5%), urinary tract infection (1%), GI or abdominal hemorrhage (1.0%), and deep vein thrombosis/pulmonary embolism (0.3%).
“Another important finding from this study is that the practice of bariatric surgery has shifted from open surgery to laparoscopic surgery. To our knowledge, this is the first study to document greater use of laparoscopic bariatric surgery than open bariatric surgery. Laparoscopy was used in 76% of gastric bypass procedures and in 92% of restrictive procedures,” the researchers said.
In a discussion accompanying the report, Dr. Ravi Moonka, a surgeon at the Virginia Mason Medical Center, Seattle, followed up on an observation that less than one-third of the medical centers affiliated with the university health system opted to participate in this study, saying that those “presumably are the centers that think they have good results.”
In that case, the study findings reflect “what excellent centers do and not what the average center does,” he said (Arch. Surg. 2006;141:450).
Dr. Moonka also noted that these findings cannot be generalized to many practices, including his own, because he performs open procedures, usually treats patients with greater BMIs, and often operates on male patients.