A helpful blog reader send me the full PDF version of the study of the
long term outcome of weight loss surgery in Pennsylvania which was cited
in the previous blog post.
Death Rates and Causes of Death after Bariatric Surgery for Pennsylvania Residents 1994-2004. Bennet I. Omalu et. al. Arch Surg. 2007;142(10):923-928.
Typically
when a surgeon tells you the mortality rate for a surgery, he tells you
only the percentage of those who died within 30 days of the surgery.
This study looked both at the actual deaths within 30 days after surgery
and in the death rate in the years after the surgery.
As the
study reports, in the 16,683 people who had weight loss surgery in
Pennsylvania between 1994 and 2004,
.9% died within 30 days of the
surgery. That translated into 150 people.
But wait. That
statistic was taken from the group as a whole. When the population is
broken out by age, a much scarier statistic emerges: In the age group
55-64 1.53% were dead within 30 days, or 15 out of 1000 who had the
surgery. And for the age group of those 65 and older, 3.1% died within
30 days, or 3 out of every hundred.
But that was just in the
first 30 days after surgery. The study looked at time since surgery, and
with each passing year the number of dead grew greater.
By one
year after surgery, 2.1% of the group had died. (Twenty-one out of every
thousand.) By two years, 2.9%. Then things got worse. Three years after
they had had the surgery, 3.7% were dead. By four years, 4.8% and by
five years, 6.4%. The authors of this study remark that they did
not follow up on the results of subsequent surgeries. But other studies
have found that many people who have weight loss surgery require one or
more follow up surgeries in the years that follow the initial surgery.
It is likely that each subsequent surgery raises the risk of further
complications and death.
Another chilling statistic emerged from
the analysis of this data. In a population of the same size of the same
demographic make up, the expected number of suicides would be 2.
However, in this group, there were 16 suicides and an additional 14 drug
overdose deaths. Most of these occurred at least one year after the
surgery. The authors of the study speculate that many of the drug
overdoses were probably suicides too, and flag this as a serious problem
that requires more study.
What was missing in this study was one
important piece of information: the weight loss achieved by the people
who died. The authors assume that the high death rate is due to health
conditions contracted while obese or due to weight regain. But this is
only speculation. They did not review any statistics about the size of
the people at death, which would have been difficult to do since only
about 1/3 of these victims were autopsied.
But based on stories I
have heard and cases like Mrs. Yamin's it may be premature to assume
that the deaths were caused by obesity. Mrs. Yamin weighed 100 lbs at
her death.
Instead deaths may have been caused by long term
malnutrition--i.e. starvation. Though the most common cause of death
listed on death certificates after a year was cardiovascular (i.e. heart
attacks) that is what kills a lot of people with anorexia and
starvation. When the body is no longer absorbing nutrients the
electrolytes can become dangerously unbalanced and that causes heart
attack. Without independent autopsies, it is very hard to know what
really happened.
Doctors don't like autopsies, because a patient
who didn't have an autopsy is a patient whose family is going to have a
much tougher time suing for malpractice. So if a heart stops beating,
well, write it down as cardiovascular death, and since the person was
once fat, who is going to challenge it?
But folks, please take
these statistics seriously.
And please note that the things that killed
people within the first 30 days were NOT necessarily caused by obesity.
Among the biggest killers were pulmonary embolism (20.7% of all early
deaths)and sepsis (i.e. infection that spread through the body causing
organ shut down). Sepsis killed 11.3% of those who died in the first 30
days. One out of four died of vaguely specified "therapeutic
complications" which is a catchall term entered on the death certificate
that included things like sepsis, bleeding, ruptured surgical wounds,
etc.
One last word. Many people erroneously believe that before a
doctor can perform a specific kind of surgery, that surgery must
undergo the same kind of safety testing and approval process that drugs
get. This is not true. Surgeons can perform any surgery they want, as
long as they are licensed surgeons.
There is only one limitation
on what kind of surgeries are performed: whether or not insurance
companies will pay for them. Most insurers won't pay for operations that
have a poor safety record--once they have enough data to know that the
operation isn't safe.
But weight loss surgery is usually NOT
paid for by insurers. Like plastic surgery, it is a surgery that
patients pay for out of their own funds. This is one reason surgeons
promote it so strongly. There are no forms for them to to fill out, no
limit on what they can charge, and most importantly, no evaluating the
patient's suitability for the surgery by pesky insurance review boards.
All the doctor has to do is sell the patient on the operation, and the
fun can begin.
So don't let yourself become a victim of a
surgeon who has found a dandy way to make himself a multi-millionaire.
And don't trust that the doctor who stands to make $25,000 for a few
hours of work has your welfare in mind when he assures you that a
surgery is no more dangerous than crossing the street. Remember,
surgeons rarely track the outcome of their surgeries beyond six weeks.
But as the Pennsylvania study suggests weight loss surgery keeps on
killing for years after the initial surgery.