whoa!!! wait a minute! what he's talking about is OPERATION-RELATED mortality - deaths that occur within 30 days of the operation. he's NOT talking about long-term mortality related to the surgery.
and i think his numbers are off.
here's a 2007 study from Florida that reported an in-hospital mortality of 0.28%, based on 19,174 patients. Murr MM, Martin T et al. A state-wide review of contemporary outcomes of gastric bypass in Florida: does provider volume impact outcomes? Ann Surg. 2007 May;245(5):699-706. - and YES - surgeon experience was VERY important.
Flancbaum and Belsley reported 1.2% 1-month mortality based on 1000 consecutive patients in their VERY busy practice that sees many very complicated, high-risk patients. Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007 Apr;11(4):500-7.
and factors affecting mortality were older age, and how sick these people were.
bottom line, i've also seen some overall numbers that put the mortality at less than 1%, but there are many factors that affect this number, including the surgeon's skill and experience, and the size and overall health of the patient.
that's one of the main reasons that everyone is urged to be in the BEST POSSIBLE CONDITION going into the surgery.
oh. and a PS. a group in Connecticut - at a hospital that's affiliated with Yale? UConn med? not sure. but they surveyed PCPs and found that less than half of them correctly identified the operative mortality rate. "48% identified the mortality rate of surgery as <1%, with 4% of respondents reporting >10%." Perlman SE, Reinhold RB, Nadzam GS.How do family practitioners perceive surgery for the morbidly obese? Surg Obes Relat Dis. 2007 Apr 17;
SSOOOO if the doc who told you this is a PCP, it's possible that he's not properly informed.
Heather/Wyllen is a social scientist and can explain how studies can be skewed. It's really interesting. You really can make statistics say almost anything you want.
Heather/Wyllen is a social scientist and can explain how studies can be skewed. It's really interesting. You really can make statistics say almost anything you want.
Awww... thanks!
I think in this case it's a matter of defining terms carefully. Jiffypop more clearly defined what the mortality rate in this case refers to (deaths occurring up to 30 days post surgery). It sounds like these rates range in the studies, to some degree. The original posters figure -- 1/200 deaths is, as Jay mentioned, .5% (one half of one percent) -- sounds like it IS within the range Jiffy mentioned.
BUT! You can't look at these numbers in isolation! And that's important. You need to look at the samples from the studies: are the patients high risk? were the surgeons experienced? These are just 2 issues Jiffypop raised. I'm sure there are more.
And then Jay raises the point that ALL surgeries are risky. Is WLS more risky than other surgeries? Especially other surgeries with similar patients? So, we need better comparisons to evaluate the risks here.
Finally, the reason many people have WLS is because of other mortality risk factors -- should someone who has a great risk of dying of something else NOT have WLS because of its risks? Obviously, these are decisions everyone needs to make individually, with the proper medical professionals.
WooChx, sometimes people do die from WLS (as with all surgeries). But, given Jiffypop's definition, I think it's impossible for one person to die a month here -- we just don't have that many people who are having surgery each month!!
thanks, ya'll for jumping in here. one of the reasons i cited the studies above was to show that there's a WIDE RANGE of mortality statistics, and that many other factors go into determining any individual's risk of surgery-related death.
but bottom line, the implication for anyone considering surgery is that a mortality rate of 1 in 200 [0.5%] is a BENCHMARK - think of it as a national average. the % of patients that YOUR SURGEON has lost within 1 month is the number you want to get to - and you want to hear the reasons for that.
if the surgeon's rate is AT OR BELOW this average %, chances are this person has the experience to deal with issues. if the surgeon's rate is ABOVE this %, then more questions are needed, like 'how many of the most difficult cases do you get [someone like Flancbaum would answer that he takes the cases that everyone else considers to be too high risk for surgery, and if you're not considered 'high risk, then take that into consideration as well].' other questions would be something like 'why did these people die?'
my surgeon, after doing these surgeries for more than 5 years and logging more than 2000 patients, had lost 3 patients in that time. and one of them was a woman who decided to get on a plane a couple of weeks after her surgery, and boarded the plane with abdominal pain. she didn't want to delay her trip. she got off the plane in excruciating pain, and refused medical treatment, wanting to fly from Nevada BACK to NJ to see the surgeon. she died from a massive infection a couple of hours after landing.
so, because of the timing [within one month of surgery], her death was attributed to the surgery, but she didn't have to die.
the other two were VERY high risk, very heavy, had lost no weight beforehand, severe respiratory problems, high blood pressure, diabetes, in short, all the horrible risk factors that we deal with.
sooooo, this is yet another reason we always say DO YOUR HOMEWORK. ASK LOTS OF QUESTIONS
I just asked my new rheumatologist this, and he said that I shouldn't worry about the "national" statistics, nearly as much as my surgeon's personal statistics, and their experience with patients my size.
I'm actually kind of excited (and afraid), because I'd been told by doctors in Illinois that I wasn't a good WLS candidate, and (at least for the reasons I'd been told) the new rheumatologist didn't agree. He said my tendency towards infection (since I didn't have a resistance to strong antibiotics) could be dealt with if the surgeon knew of it ahead of time, and that the autoimmune disease (even if it did turn out to be a connective tissue problem) wouldn't be an issue with the lapband, because again it could be monitored closely, and if I developed a problem it could be removed without much risk of complications.
Wooh, that leaves me with a lot to think about and a lot of work to do (I'm on medicare so preliminary work is required, but not payed for. The surgery itself is thankfully, but lapband as I understand it is a little bit more complicated to get approval for than gastric bypass).
When you are dealing with people that weigh hundreds of pounds over weight, right away they are at a higher risk. Then you are talking about all the pre existing conditions that they may have that can contribute to their deaths. Add to that as well, people that don't do their homework and pick surgeons that have lacking screening processes for candidates.
I in 100 sounds about right.
I know on another board I belong to we have had two deaths in the last two years. The deaths were a month away from one another and both people had the same surgeon. One died from a leak, the other had a pre existing condition (blood issues) and I highly feel she should never have been operated on in first place.
your rheumatologist sounds like a smart person. and he's SOOO right about making sure that the surgeon knows EVERYTHING about you - they absolutely want to avoid surprises!!!!
also, if you're going for lapband, these WLS mortality stats that we've been discussing don't apply!!!! we were giving you numbers for the gastric bypass. not sure what the risk numbers are for lapband, but i'll look for some, if you want.
Colleen,
I just have to chime in here and let you know that I have RA also (was diagnosed in Wausau by Dr. Davis) and had the RNY 3/1/06. The only med I needed to adjust was the enbrel. I missed a week, but didn't see any major problems. I continued with the celebrex, methotrexate & folic acid after the surgery. I healed well. I did end up with a bad cold the week after surgery which may or may not have happened if I hadn't had RA.
If you would like more specifics, send me a private message & I will be glad to share.
Jiffypop, thanks too. I discussed both procedures with the rheumy, and am not set on either one yet. My understanding is that the lapband is a lower risk procedure, and it would probably be my first choice unless talking with the surgeon would change my mind. I'm trying to reserve judgement, it's just a lot smaller cognitive jump to consider lapband, than removal of a good part of my digestive tract (even when my tonsils were taken out at 5, I wondered why they were taking something out of me that was supposed to be in there - you know that whole idea of "what if I need that later").
and here's another little note about surgical risks. while researching another topic for my job, i came across some comments by a surgeon who was talking about the risks of some type of abdominal surgery [like bowel ostomies or something] - and he said that the risks were 'neglible - like 1 in 100'
so, let's just keep things in perspective here, ok?
Dr. said mortality rate is 1 in 200?? Seriously??
From another RA person
