Friday, August 07, 2009
Weight Loss surgery death rates down? No evidence of this!
An article on aol news with the headline of "Obesity Surgery death rates low" reads:
-Obese, but worried that surgery for it might kill you? The risk of that has dropped dramatically, and now is no greater than for having a gall bladder out, a hip replaced or most other major operations, new research shows.
Sounds good, doesn't it? Now you can have a gastric bypass and have it only be as risky as gall bladder surgery i.e. 1 death in 7000 surgeries.
But wait! First of all the study didn't exactly say that at all.
The finding of the study, another Dr David Flum study to be published in the NEJ on August 13th, which looked at the medical records of 3,412 gastric bypass patients and 1,198 given stomach bands i.e. adjustable lap band, was that there were 3 deaths in 1000 patients so that's still _a lot_ more risky than gall bladder surgery.
[to be fair with statistics: there are multiple articles stating that in Australia the risk is only 1 death in 1000 patients. However one death is one too many.~~Michael]
Flum's own studies of 62,000 gastric bypass patients 6 years ago, found that 1 in 50 died within 30 days.
The "less deaths now" are attributed to "newer methods" and lap surgery. However, if you average the very LOW death rate of the adjustable lap band surgery in with gastric bypass, that's far more likely where the lower death rate figures come from.
That is the death rate on adjustable lap band surgery is 1 in 7000 or the same as a gall bladder surgery. And I sincerely doubt the death rate on gastric bypass has been reduced that much in the 6 years since Flum's other study (report delivered to the College of surgeons in Oct 21, 2003.[Study title: The Impact of Bariatric Surgery on Patient Survival: A Population-Based Study]) which was never formally published and which concluded by comparing desperately ill fat people hospitalized for other reasons than WLS, that even with such a high death rate it was slightly more risky to be fat than to have a gastric bypass.
It's called "cooking the books" and it's easy to see how they arrived at those figures. In 1198 lap bands, there were likely no deaths! And in 3412 gastric bypasses, there were likely 68 deaths within 30 days of surgery, however they probably took the table death figure which is 1 percent so that's 34 deaths.
Now lump them all together and that's 34 deaths in 4610 WLS surgeries or 8 deaths in 1000 surgeries. That's still more than the 3 per 1000 surgeries they are claiming so more cooking must have occurred. Simply, I have read nothing about the study being randomized and greatly suspect it was not randomized which means they could pick and choose the members of the cohort. That is, at the 10 hospitals they studied, there were likely far more patients than 4610 who had WLS but many were not included in the study for this or that reason.
Anyway, you get the gist. The gastric bypass isn't likely, any safer than it was in Dr Flum's study, 6 years ago. They just uh..re-computed because the results from the 2003 study which studied 62,000 cases of gastric bypass done in one hospital, didn't look so good (2 percent death rate within 30 days).
Fortunately for those providing gastric bypass, few will "do the math" or notice that the study was not 'randomized'. Unfortunately for those patients who have gastric bypass which Dr Terry Simpson emphasizes is over 100 years old (is essentially a modified Billroth II surgery originally done for duodenal ulcer), many may go in thinking that by some magic, the gastric bypass is now "safer".
I would suggest those who question, go to Dr Simpson's website and listen to the part of his online seminar about why he prefers the lap band to the gastric bypass and duodenal switch.
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