Who Should Not get Bariatric Surgery?
With obesity being extremely difficult to treat, and the fact that bariatric surgery is the most effective means induce weight loss for the severely obese, it makes sense that bariatric surgery rates have skyrocketed.
While the surgery certainly is successful in achieving weight loss, the jury is still out whether it is worth the risk of mortality that is associated with in patient with specific health factors.
There are certain factors that do increase your risk of dying, and they include
1. Gastric Bypass is associated with increased mortality risk vs. gastric band
2. Open surgical technique has higher mortality risk vs. laparoscopic surgical techniques
3. Males are at higher risk of mortality.
4. Patients over 60 years old have an increased risk of mortality
5. The type of insurance - private or Medicare, with Medicare patients having a higher risk of mortality.
6. The presence of type 2 diabetes increases mortality risk.
This is vitally important for not only the surgeon, but also for the patient who is deciding whether it is best for them to have the surgery or not. Patients had a higher in-hospital mortality if they were diabetic males 60 years or older who underwent gastric bypass surgery, with an open rather than laparoscopic surgery, and were covered by Medicare insurance.
Bariatric surgery has certainly become safer over the years, and now that physicians can counsel their patients better on whether or not they are at risk with this type of surgery. Some patients could decide not to do surgery because of their risk, and go with alternative therapy, such as medical weight management.
At my practice, I have been successful in helping patients lose weight so that it is medically safer for them to undergo surgery, and I have also been able to help patients lose weight and avoid surgery entirely. With a structured and medically supervised program, we are also able to monitor post-bariatric surgery patients as well, ensuring they receive adequate and balanced nutrition.
American Society for Metabolic and Bariatric Surgery (ASMBS) 28th Annual Meeting: Abstract PL-108. Presented June 15, 2011.