How Safe is Bariatric Surgery?

According to some reports, bariatric surgery is now the second most common abdominal surgical procedure performed in the US.

However, despite the well-documented beneficial outcomes, critics continue to question the safety of this treatment option for severe obesity. There is also oft-cited concern about the quality of treatment provided across centres.

These questions were now addressed in a study by Nancy Birkmeyer and colleagues on behalf of the Michigan Bariatric Surgery Collaborative, published in a recent issue of JAMA.

The study looks at complications occurring within 30 days of surgery across 25 hospitals and 62 surgeons statewide, in 15,275 Michigan patients undergoing common bariatric procedures between 2006 and 2009.

Overall, 7.3% of patients experienced perioperative complications, most of which were wound problems and other minor complications.

Serious complications were most common after gastric bypass (3.6%), followed by sleeve gastrectomy (2.2%), and laparoscopic adjustable gastric band (0.9%) procedures.

Mortality occurred in 0.04% of laparoscopic adjustable gastric band, 0 sleeve gastrectomy, and 0.14% of the gastric bypass patients.

After adjustment for patient characteristics and procedure mix, rates of serious complications varied from 1.6% to 3.5% across hospitals.

Average annual procedure volume was inversely associated with rates of serious complications at both the hospital level (< 150 cases, 4.1%; 150-299 cases, 2.7%; and > 300 cases, 2.3%) and surgeon level (< 100 cases, 3.8%; 100-249 cases, 2.4%; > 250 cases, 1.9%).

Adjusted rates of serious complications were similar in accredited Centres of Excellence (COE) and non-COE hospitals.

The study makes three important points:

1) The overall early complication rates of bariatric surgery are surprisingly low.

2) Both centre and surgeon volume are important determinants of risk.

3) COE accreditation does not appear to be relevant for short-term outcomes.

While this study only addresses the safety and not the long-term efficacy of bariatric surgery, it should at least allay any concerns about the surgical risks of these procedures.

With the accumulating evidence on the positive long-term outcomes of surgery (e.g. the recent blog post on surgical remission of type 2 diabetes), it is very likely that we will continue seeing exponential increases in bariatric surgery numbers in many countries and jurisdictions around the world.

Indeed, individuals who remain opposed to expanding the provision of bariatric surgery to severely obese patients citing safety concerns, should ask themselves whether their objections to expansion of this useful and effective treatment is ideological and a reflection of anti-weight bias and discrimination rather than based on a sound understanding of the available data.

Edmonton, Alberta

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Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, Finks JF, Carlin AM, Birkmeyer JD, & Michigan Bariatric Surgery Collaborative (2010). Hospital complication rates with bariatric surgery in Michigan. JAMA : the journal of the American Medical Association, 304 (4), 435-42 PMID: 20664044