April 22, 2008

More on the Actual Gastric Bypass Death Rate

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.

Don't let yourself become a victim.

26 comments:

The Old Man & His Dog said...

Very scary stuff. My fiance' has a cousin that is her age (she's 26) that just had this surgery done about 2 yrs ago. Her reason for the surgery at about the age of 24? She was about 50lbs overweight. My fiance' thought it was just about the best idea in the world and talked to me about doing it herself. I told my fiance' that she was crazy for even considering it. That her cousin's body would be getting little to no nutrients and her surgery happened to be irreversible. Told her it would be her cousin's biggest mistake of her life and might even cause her death. All of it so she could look better. Then she lost all the weight and now has all this flabby skin that she needs to have removed but can't afford to have done, so she still looks like crap. It's a shame so many people are so vain.

Anonymous said...

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?

Jenny--this is a much broader problem (but perhaps you already recognize that). Hypoglycemia unawareness, dead-in-bed syndrome and sudden death, I believe, are rarely listed as 'cause of death.' These deaths--attributable to insulin usage--can (and probably ARE) ascribed to 'natural causes.' The drug itself, as well as doctors who prescribe but fail to warn/educate are never blamed. I believe this is a serious problem that needs more exposure; it is also a problem of which many medical examiners are unaware.

This is a greater problem for Type 1's--but as the medical community ramps up the numbers of drugs taken by Type 2's (including insulin), the counterregulatory responses more commonly available in Type 2's will also begin to fail.

--Melody

Jenny said...

Melody,

I recall reading something that discussed the appalling decrease in autopsies and explained that when autopsies are done the actual cause of death is often quite different than what had been believed to be the cause.

One problem is the expense. Insurance doesn't pay for it. But this could have been surmounted if doctors were aggressive in demanding autopsies.

But to me, one of the most disturbing features of the way doctors practice medicine--the thing that makes it an "art" rather than a science, is that they NEVER follow up on anything and appear not to want to know if their diagnoses or treatments are effective.

An engineer checks to see if a solution they prescribe works. The doctors do not. How many times has a doctor given you a prescription and asked you what its effect was?

Boz said...

I think what the big picture is what risks are we willing to take. I've nearly killed myself walking around in a low sugar daze on night alone. I fell down some stair, waking up in a pool of my own urine and missing the end of one finger. Not an episode I care to repeat. All signs were normal when I went to bed. But do the risks of duodenal bypass out-weigh my fears of diabetes complications? Maybe. My wife had bariatric bypass 4 years ago w/ no complications thus far. We all look forward to a real cure, so anything that comes along is worth consideration.

Jenny said...

Boz,

You're absolutely right, that it comes down to figuring out what risks we are willing to take.

As long as people realize there ARE risks.

My concern with bariatric surgery is the way that the surgeons who promote it so heavily on TV and elsewhere obscure the risks.

They are telling people it is the same, risk-wise as gall bladder surgery--a surgery most of us think of as being almost risk-free.

That's why I am highlighting these statistics. There isn't a 6% five year death rate from gall bladder surgery. But when one out of fifteen people who opt for a surgery will be dead in five years--far more, apparently, than the number who would die if they stayed alive without the surgery, even being obese. Well, it should make you think.

But most people don't understand risk. Which is why most people are convinced that they'll eventually win the lottery if they buy a ticket every week (odds, 1 in several million) while they don't worry about dying from a dangerous surgery (odds 1 in 15.)

Anonymous said...

Bariatric surgery is a fascinating experimental procedure. Understanding how it can resolve Type II diabetes will be huge stride towards effective treatment.

But as standard therapy? No thanks.

Chris B.

Anonymous said...

my mother & cousin just passed away due to the gastric bypass surgery! its very dangerous & it will claim your life. both had the surgery around 6-7yrs ago and died 6 mos apart~ it causes do many problems & make you DEPENDANT on medicines that can poiseion your blood!!! they developed animia..ulcers...cysts....blood clots....pancritis...and swollen feet closer to death!! this is your life! anyone thinking of getting this surgery please dont!!!

tear drop
:(

any questions you can email me anytime @ quanasquanas@yahoo.com

Jenny said...

Anonymous (July 14),

My condolences on the tragic death of your mother and cousin.

There is currently no real regulation of surgeons. They can perform any surgery they want, particularly those that are not paid for by insurers. They will only be shut down by their peers if a lot of their patients die in the operating room. If they die six weeks after surgery, no one will ever track that death.

Victims' families must speak up. Go to your newspaper and TV news people demand they tell your story to counter all the stories of WLS success that they have done that have lured so many people to risk these questionable surgeries.

Anonymous said...

My sister died at 43 from having the surgery. she went from 350 lbs, to 95 lbs. the first sign things were going wrong was when he blood sugar began to bottom out. Then she began to fall quite often.She however had not guidance as her doctor removed her from his support group when she spoke out against the surgery. she was on her own. she died from malnurtrion. I would love to see lawsuits against these deaths. bariatric surgery should be followed for years to see just what the death rates truly are and the cause. If you love the one who wants this surgery to look good, feel good, then don't let them have the surgery. Encourage them to eat healthier. My sister, the year before she died, began throwing up her own stool, was having to have an endoscope to find out why. She aspirated on her own stool. was in ICU for 6 weeks on a vent, then a trach. rehab for another month. she went through so much that last year.

Jenny said...

Anonymous,

I am so sorry to hear about your sister's tragic death. The media are promoting these surgeries so strongly because those who profit from them have the resources to do the PR.

Only if people like you are willing to speak out publicly will the truth become known. Thanks for having the courage to do this.

Anonymous said...

i am about to have the rny gastric bypass, a lot of what i read here is actually untrue.insurances do pay for this surgery ,there are a few types that they wont pay for .EX the duodenal switch or the sleeve. howeverthere is also a bigger cryteria now you cannot have this surgery done if you are less than 100 pounds overweight.second you need to go through at least 6 months of education testing and psychological exams in order to be concidered for thid operation. and on top of this you have to be educated a lot of us do know wnat vitamins we will need to take ,mybe for the rest of our lives,i however would rather take a vitamin than the 12 meds i take daily for all my other problems

farmlady said...

I'd like to know what genius decided it was a good idea to cut most of the stomach, duodenum, pancreatic enzymes, liver and gall bladder and impressive portion of the small intestine out of the line of function for food digestion? That IS all your food digestion. Why does it not impress on these doctors, or these patients that these are extremely important to our bodies?

saieed said...

I have pondered for many years whether to have this surgery or not. I am about 90 lbs overweight. We have one of the best bariatric clinics and surgeons in the country right here. I know 4 people, one of them is a relative, who has had the surgery. She is very happy, and much healthier, because of it.
I wonder if the results have to do with the extremes, and if they are like all the things in this world...some people abuse them- things that can be used for good. Like maybe doctors that shouldn't be doing this surgery at all; are doing this surgery. And maybe people who really wish they could have it, but are not in any condition at all to have the surgery, are having it.
I have also read alot about how you have to have all of this pre and post op nutritional and psyc. counseling. I have read that it is to teach people how to properly hydrate themselves while their bodies are flushing these huge quantities of fats through their kidneys every day. There is also this insulin backlash thing. Like, the wieghtloss is so fast, that a once pre diabetic person can go normalized in a very short period of time. Combine this with a person who is not hydrating and eating as per the strict diet guidelines, next thing you know, you have someone in a hypoglycemic condition or shock. The flushing of all the fats through the kidneys does not help this situation either. So, can you immagine all the stress this puts on these people's bodies? And this is before we have even considered the individual's pre surgical state? Like, how bad was there diabetes beforehand? Did they have sleep apnea?, Heart condidtions, Gastric troubles. Add on to this the burden of your own body trying to heal itself. It's a really scary thing. That's why I haven't done it myself yet. But, the 4 people I know, have said, they followed the instructions of the center, and the clinicians to the "T", but again, these people were all under 35 years old, and under 325 lbs., and they are doing wonderfull. No sagging skin, because they do weight bearing exercises, and running. But, I am still scared to death. Is it worth it? I could die and leave my children parentless.

Jenny said...

Saieed,

Unfortunately, it isn't that simple.

You can't find out which surgeons are competent because doctors aren't honest about this. My parents worked for a major hospital and knew which guys drank too much and had higher than normal failure rates, but no one stopped them from practicing.

You can't know which hospitals have MRSA epidemics. There's no requirement to report. When I was hospitalized after an accident, my roommate had gone blind in one eye from MRSA contracted at our other local hospital after being there for something else.

You can't know the state of your tissues and whether you'll react to the substances they use to stitch you up.

You can't know how you will respond to anesthetic. Some people have bad reactions.

You can't know a lot of things, which is why when you have surgery you have to sign a form that says you give up all right to sue about any of the many bad outcomes that are possible.

Jo said...

Ok, you got my attention. I was planning to go for bypass surgery in the very near future and my wife(who sent me this blog) and family are very against it. After reading this I am not sure. What about the lap band, are the results/statistics as gloomy??

Jo

Jenny said...

Jo,

You will have to put some time into researching this issue on your own. The statistics are available online. For some people it works well, for others it doesn't. Doctors are not frank with patients and surgeons are notorious for deprecating the potential problems with ALL surgeries and giving people false ideas of what recovery involves.
People do have successful outcomes that please them, but you need to find a VERY good doctor, who has a lot of experience with the surgeries, and a lot of training, since anyone can do these surgeries who has a surgery credential.
Check the doctor's credentials, his board specialty, and the quality of the hospital out of which he operates. Ask him how many of his bypass patients have died, how many have had to have multiple surgeries, and if he says none to the latter, it's a warning sign.
This is one of those things where the percentage of those who do well is high, but the small percent who DON'T do well are in very bad shape, and you can't really know how lucky you will be.

Susie said...

A girl I went to school with, in the 70s, had gastric bypass in the early 2000s, saying she would rather die, than live her life overweight! A few years after her bypass, she did die. Leaving a husband and 2 children mourning her death. Cause of death? Heart failure. She was under 50 years old.

Susie said...

My sister in law had her bypass in July 2008 (i think it was). Just this week she was hospitalized for a mild heart attack while out of town. She now has to make an appointment with her hometown doctor for tests. Due to malnutrition? I think so, we'll see. I have considered bypass for several years but now am convinced I don't want it. Too scary for me!

Linda said...

I am 5'5" and weigh 282.4 lbs. In 10 months I have lost only 24 lbs on my own. I am getting ready to have weight loss surgery because I am only 48 years old and have high cholesterol, Type II Diabetes, high triglycerides, degenerative joint disease and a multitude of additional aches and pains. I can barely walk due to the pain in my knees and refuse to go on disability. Losing weight is not an easy task - in fact I am on Weight Watchers right now and since 12/6, I have lost 10 pounds. While any loss is an achievement, knowing that I will be healthier if I have the surgery is in my opinion worth the risk. I am a mother and a grandmother and want to be around for them all. I have gone back and forth with myself for nearly a year regarding this surgery and just yesterday told the surgeon to submit me for insurance approval. Am I scared - yes, who wouldn't be but I am putting all of my faith into my prayers and feel deep inside that all will be fine.

T said...

My mother had the gasrtric bypass surgery in 2004 at the age of 45 she wanted to be there for her grand kids she had diabetes and could barley walk because of her knees. It was great for the first 4 years she could walk with the kids she even was able to take them for the summer then.....she got sick from malnutrition. Her body was not retaining any nurtrion from the food that she was eating, and she passed away a year later, why take the risk of not being there for you loved ones

Joseph Henry Stevens said...
This comment has been removed by a blog administrator.
Jenny said...

Please do not post about scammy weight loss products pretending to be discussing your weight loss. I have deleted several posts when it became clear that the only reason people were posting here was to mention the product name.

There is NO product you can buy that will eliminate hunger and make you lose weight fast. The sooner you realize that, the better off you will be.

Danielle Osborne said...

Thanks for your post. It's very valuable for people like me who has been seeking alternative to bypass surgery. I'd seen many people who suffers years with not much research prior to a decision. This blog is an eye opener.

Sharon said...

Just found out my sister-in-law died suddenly yesterday morning. She had surgery about 4 yrs ago and for the past 2 years has been going to Mayo clinic and the "teams" couldn't figure out what was wrong with her. After reading this thread and others, it's kinda obvious to me. Falling, breaking ankle, falling again, breaking arm on other side. Unexplained Blood sugar dropping to 20's with multiple ER visits, pancreatitis, w/multiple (benign) cysts and sooo much pain, unexplained balloon swelling in legs, COPD, a 2nd corrective surgery, restricted diet, and many other problems. It all makes sense now. What's sad is that the day before she reported she finally had started feeling better, and was off her morphine, and down to half of her other drugs. She said goodbye to her husband around 6am and her 13yr old son found her on floor 2hrs later when it was time for her to take him to school and he couldn't wake her up. She was only 47yrs young.

Jenny said...

Sharon,

Please accept my condolences on your sister-in-law's tragic death. Perhaps your courageous reporting will keep someone from rushing into this surgery before doing their research.

Sharon said...

Got word today coroner thinks it was an embolism that killed her, another symptom on the list. People need to read this article. http://www.lindabacon.org/HAESbook/pdf_files/HAES_Bariatric-Surgery.pdf

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