The Agency for Healthcare Research and Quality—an arm of the federal government’s public health service—has revealed that in 2001–2002, about four in 10 bariatric surgery patients experienced significant complications within 180 days after their surgery. Although the overall death rate among these patients was low, 7% of the 2,500 patients studied were readmitted to the hospital less than 6 months after their surgery.

“You have to be well informed as a consumer in terms of what level of expertise you get in your hospital or doctor,” says Eric DeMaria, MD, a bariatric surgeon and researcher at Duke University in Durham, NC. “As bariatric surgery is being sought by teens and the elderly, surgeons are beginning to recognize which patients will benefit most from surgery and which patients need to avoid it, lose weight first, or have their weight-loss surgery in stages that lower their risk of complications.”

The study shows that postoperative complications increased costs for bariatric surgery. For those who experienced complications, the average cost climbed from $25,000 per patient to $37,000. For those who were readmitted to the hospital for complications, the total bill averaged $65,000.

The recent study and many others that preceded it have elicited strong objections from leaders in the field of bariatric surgery, who have called them outdated, shoddy, and unnecessarily alarming.

According to Harvey Sugerman, MD, in Richmond, VA—who chairs a new committee established by the American Society for Bariatric Surgery to accredit centers and surgeons performing the procedures—during the period studied, techniques for the surgery required large, open incisions, which increased the risk of postoperative complications than with the newer, laparoscopic techniques that account for most bariatric surgeries. During the same period, Sugerman says, more bariatric surgeries were done by physicians who were inadequately trained or who did not perform these operations frequently. Sugarman also complained that, by using insurance claims and billing documents to collect its medical data, the government study overcounted, miscounted, and mischaracterized postoperative complaints.

“The latest study gives more ammunition to health insurers to say we shouldn’t cover this,” says Sugerman. “It’s unfortunate because in the right hands, this surgery is lifesaving.”

[www.latimes.com, July 31, 2006]