Weight-loss Surgeons Now Can Identify Highest-risk Patients Before Surgery: Leading Bariatric Surgeon Discusses New Assessment Tool's Role in Making Procedure Even Safer
Bariatric surgery is one of the fastest growing segments of elective surgeries in the U. S., climbing from just 10,000 procedures in 1995 to an estimated 200,000+ this year alone. As more and more Americans choose surgery to address obesity, a new study shows that, by assessing patients using five key indicators, surgeons can identify those most at risk of mortality before performing the procedure.
Brooklyn, NY (PRWEB) May 26, 2007
Bariatric surgery - procedures that modify the size and capacity of the stomach in an effort to help obese patients lose weight - is one of the fastest growing segments of elective surgeries in the U. S., climbing from just 10,000 procedures in 1995 to an estimated 200,000+ this year alone. As more and more Americans choose surgery to address obesity, a new study shows that, by assessing patients using five key indicators, surgeons can identify those most at risk of mortality before performing the procedure.
"Obesity itself is a primary factor in several of the leading causes of death in this country, including heart disease, stroke and some cancers," notes Dr. Piotr J. Gorecki, MD, F. A.C. S, Medical Director of the Brooklyn Center for Advanced Laparoscopy and Director of the Bariatric Surgery Program at New York Methodist Hospital, "This means the long-term health risks associated with obesity itself usually far outweigh the immediate risks involved in bariatric surgery," Dr. Gorecki adds. "However, finding effective ways to reduce even the smallest chance of death is a key focus of every surgery, and the new risk assessment protocol is a powerful way to further that goal."
Five Barometers for Successful Surgery
The new risk assessment tool focuses on five crucial factors: BMI, age, gender, blood pressure and risk of developing blood clots in the lungs. It was first developed by a Duke University bariatric surgeon who, with colleagues at the medical center, applied its standards to the records of more than 4,400 bariatric surgery patients at three separate hospitals. The researchers found that being male, being over 45, having a Body Mass Index over 50, having high blood pressure and/or having a high risk of blood clots in the lungs were all associated with a higher risk of death following bariatric surgery. What's more, having multiple risk factors was associated with a higher mortality rate. For example, surgery-related deaths occurred in eight of the 2,166 patients classified as low risk (0-1 risk factors), 26 of the 2,142 patients in the medium-risk group (2-3 risk factors), and three of the 125 patients classified as high risk (4-5 risk factors). Patients in the high-risk category made up less than 3% of the study group, but their risk of death was six times that of patients with no risk factors.
"Performing this risk assessment prior to bariatric surgery is less of a tool to discourage the highest-risk patients from having surgery, but instead a barometer to aid the surgical team and the patient in preparing for the surgery," Dr. Gorecki explains. For example, patients identified as falling into four or five of the high-risk categories might require specialized monitoring or care during and after surgery, or surgeons and anesthesiologists might modify their procedures to ameliorate the risks.
"The message here is that patients should not wait until their weight and health status are dire before seeking the help of a bariatric surgeon," Dr. Gorecki adds. "Patients with no risk factors in the study - those who were under 45 with a BMI under 50, with controlled blood pressure and low risk of developing blood clots in the lungs - only had a.2%-.3% risk of surgery-related death," he notes, adding, "That's a far lower risk than the overall long-term health risks of obesity itself."
Surgical rate grows - as does obesity rate
Although considered elective, bariatric surgery is becoming more and more necessary as obesity rates in the U. S. continue to soar - particularly among the extremely obese. The RAND Corporation's recent study on obesity in the U. S. revealed that the number of obese Americans - with a BMI over 30 - rose 24% between 2000 and 2005. However, the rate of morbid obesity - defined as a BMI over 40 - surged up 50% during the same time period. And, in the category of extreme morbid obesity - with a BMI over 50 - the numbers grew by a staggering 75% over the same five-year timeframe.
"Clearly, bariatric surgery is a valuable option for those morbidly obese patients who have had no success with traditional weight loss programs, and need medical intervention to help them achieve a healthier weight for longevity and disease prevention," Dr. Gorecki notes. In fact, federally-funded health insurance policies Medicare and Medicaid have recognized bariatric surgery as a medically necessary surgical procedure for the morbidly obese. While considered a major abdominal procedure with serious risk, Dr. Gorecki points out that New York Methodist Hospital has been named a "Center of Excellence" by the American Society of Bariatric Surgery for its commitment to quality and its high success rates for patient satisfaction. He adds that prospective bariatric surgery patients at NYM undergo a rigorous screening process to ensure that the surgical option is warranted, and that less invasive options for weight loss have been exhausted.
According to Dr. Gorecki, there are two most common types of bariatric surgery. The first, Roux-en-Y Gastric Bypass Procedure, involves creating a small stomach pouch that serves as a reservoir and connects directly to the intestine (gastric bypass). The second is Laparoscopic Gastric Banding, also called Lap-Band. For this procedure, surgeons make a small laparoscopic incision and insert an adjustable band to restrict the size and capacity of the stomach. The entire procedure is done without stapling or cutting into the stomach. In addition, adjusting the band - which is done regularly during the weight loss period - does not require additional surgery. While both procedures limit the amount of food that a person can consume, gastric bypass has been shown to produce greater and more sustained weight loss than Lap-Band.
Dr. Piotr J. Gorecki, MD, F. A.C. S is a leading advanced laparoscopic surgeon with extensive practice in bariatric and foregut surgery. An assistant professor of surgery for Weill Medical College at Cornell University, Dr. Gorecki is the Chief Division of Laparoscopy, the Medical Director of the Brooklyn Center for Advanced Laparoscopy and the Director of the Bariatric Surgery Program at New York Methodist Hospital. He did his residency at New York Methodist Hospital which is affiliated with Cornell University College of Medicine and his fellowship in Minimally Invasive Surgery at Mayo Clinic. Dr. Gorecki has lectured and written widely on bariatric and laparoscopic surgery. He is current a member of the American Medical Association, the American College of Surgeons, Society of the American Gastrointestinal Endoscopic Surgeons, American Society for Bariatric Surgery and The Society of Laparoendoscopic Surgeons. More information about Dr. Gorecki and about the bariatric surgery program at NYM can be found at www. nym. org.
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