FYI Reuters News Article 12/4/02
Obesity Surgery May Be Most Risky for Heaviest Men
NEW YORK (Reuters Health) - Men who are extremely obese may be at
greatest risk of life-threatening complications from the weight-loss
surgery known as gastric bypass, new research suggests.
Doctors at the University of California, Los Angeles (UCLA) found
that among the more than 1,000 patients who had the surgery at their
center in recent years, male patients and those who were “superobese”
faced a particular risk of serious complications.
In addition, although older patients had about the same rate of life-
threatening complications as younger ones, they were more likely to
die, according to findings published in the November issue of the
Annals of Surgery.
In general, severe, life-threatening complications from gastric
bypass are relatively uncommon. In this study, about 6% of the 1,067
patients developed potentially fatal complications such as blood
clots in the lungs or bowel obstruction. Fourteen patients died, with
the risk being greater among patients older than 55. Their death rate
was 3.5%, compared with just over 1% among younger patients.
And while older patients were more likely to die from a surgery
complication, only male sex and “superobesity” were significant risk
factors for developing a life-threatening complication in the first
place, report Dr. Edward H. Livingston and his UCLA colleagues.
The researchers studied patients who had undergone an obesity surgery
known as Roux-en-Y gastric bypass between 1993 and 2000. In this
procedure, surgeons staple off a section at the top of the stomach to
form a small pouch that can hold only a small amount of food. They
also add a bypass that allows food to go around part of the small
intestine, which limits the absorption of calories.
The procedure is intended for the severely obese–generally, people
who are around 100 pounds overweight. These individuals are at high
risk of obesity-related conditions like diabetes and heart disease,
but often fail to take off pounds with diet, exercise or drugs. For
them, gastric bypass or other weight-loss surgeries may be the only
way to shed weight for the long haul.
Such surgery carries risks, however, and the new study suggests that
men–particularly the largest men–may face a greater risk of serious
complications.
For example, Livingston’s team notes, a 200-pound woman in their
study had a 4% risk of a life-threatening complication, compared with
a 7% risk for a man of the same weight. The risk was 7.5% for a 600-
pound woman, and 13% for a 600-pound man.
On the other hand, factors often thought to boost the risk of
complications–such as diabetes and a history of smoking–were not
tied to a higher risk in this study.
“Taken together,” the researchers write, “our data suggest that very
large men be counseled to lose weight before gastric bypass surgery
to minimize the risk of adverse outcomes.”
And, Livingston and colleagues add, although the death risk for older
patients appears to be “within acceptable limits,” they should be
informed that their risk is higher than that of younger patients.
Blood clots in the lungs, while infrequent, were a common cause
behind the 14 deaths, the authors point out. They urge “aggressive”
preventive measures, such as clot-preventing medication, for gastric
bypass patients.
SOURCE: Annals of Surgery 2002;236:576-582.