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Practitioners and insurers weigh risks of obesity surgery

Patient Safety Monitor Alert, March 9, 2005

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As weight-loss surgery becomes increasingly popular, practitioners and insurers are weighing the procedure's long-term side effects and safety, reports the St. Louis Post-Dispatch.

The number of such operations has risen 400% since 1999. With 140,640 bariatric surgeries performed last year, the procedure is on its way to surpassing prostate removal and hip replacement among top major surgeries.

In the past two years, patient deaths have prompted at least 10 hospitals in six states to suspend their weight-loss surgery programs. Some insurers have stopped paying for the operation, but patients are often willing to shell out $15,000 to $50,000 for the surgery.

Some hospitals are stepping up to meet the demand. About 9 million U.S. adults are at least 100 pounds overweight, which qualifies them for the surgery.

But other hospitals are dropping the surgery, citing patient deaths and rising insurance costs. Between 1-2% of patients die during or shortly after bariatric surgery, according to a health technology assessment published last year. An additional 10% to 20% of patients develop complications, including life-threatening ones.

Some states are conducting their own studies of the surgery's safety. Washington state found that its 30-day death rate for obesity surgery ranged from 0 to 40%, meaning that some surgeons were losing four out of every 10 patients.

Jeffery Thompson, MD, chief medical office for Washington's Medicare office, was shocked by the 2003 statistics and ordered a halt to the surgery for his agency's clients. A new in-depth analysis of Washington obesity surgeries found that hospitals that performed fewer than 10 operations a year had a 12% death rate, while hospitals that performed more than 100 surgeries per year had a death rate of 2%.

The CMS reinstated Medicare coverage last March, but it requires hospitals to show they can perform the surgery safely and follow-up with patients on a long-term basis. Medicare also restricted which patients could receive the operation, requiring them to be between 21 and 60 years old and suffering from one of three conditions in addition to obesity: diabetes, the need for major joint replacement, or a rare weight-related condition like pseudotumor cerebri.

Thompson calls the radical solution a way of mediating "a need versus a want" for the surgery. "We as the physicians need to understand the needs," he said. "We don't know the answers yet. And when you don't know, you're cautious and conservative."

To read the St. Louis Post-Dispatch article, click here.

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