Skinny Daily Post

Invincible.

The Agency for Healthcare Research and Quality has published a study on the post-discharge complication rates in Medical Care, a journal of the American Public Health Association.

Now, I’m one of the first people to say that bariatric surgery has many risks, and it’s essential that people research it carefully and talk to a variety of people before making a decision. It’s not easy, there are many short-term and long-term risks associated with it, and it’s not the right choice for many people.

Part of the national debate over whether these surgeries should be permitted relies on complications data, especially complications that land someone in the emergency room or the hospital. That kind of thing drives up costs and raises serious risk-benefit issues.

However, this study has me rip-roaring annoyed because it failed to separate patient-driven emergency room visits from complications due to the surgery. While the abstract [linked above] doesn’t give enough data to state this, the press release from AHCQR does.

The five most common complications were dumping syndrome, which includes vomiting, reflux, and diarrhea (nearly 20 percent); anastomosis complications (complications resulting from the surgical joining of the intestine and stomach), such as leaks or strictures (12 percent); abdominal hernias (7 percent); infections (6 percent); and pneumonia (4 percent). The overall death rate for entire the 180-day postoperative period studied was lowó0.2 percent.

See that ‘dumping syndrome’ line up there? Dumping syndrome is caused by eating too many carbs or too much fat at a time. In other words, the patient did this. It’s not a problem with the surgery per se, but rather with the patient’s food choices.

And, believe me, I’ve done it myself. In fact, I ended up with a hospital admission a few months after surgery because I had a blockage. What caused it? It wasn’t the surgery per se. It was a wad of ‘vegetable matter,’ specifically due to the fact that I’d DISOBEYED the surgeon’s instructions and I didn’t peel a couple of peaches and nectarines.

It wasn’t the surgery. It was patient compliance.

It’s irresponsible to lump these patient compliance issues under the heading of surgical complications. It’s a combined failure of patient education, patient motivation, patient missteps, patient trying to push the envelope, and we can perhaps add some failures of the healthcare team in evaluating candidates and in efforts to determine whether instructions are understood.

But we can’t consider this a complication of the surgery.

As for the REAL complications, the numbers are a disgrace. Too many surgeons do not have enough experience in these surgeries, and way too many people are being discharged too early with inadequate care.

However, since the data they used were from 2000-2002, when relatively few surgeons were skilled in this, and there were many who were jumping on the bandwagon with little or no understanding of what was involved, the information is already outdated. Furthermore, there were actually insurance companies who would NOT permit a specialist to perform the surgery! They would cover the costs only if a general surgeon performed it!

Since that time, the American Society of Bariatric Surgery has instituted a Centers of Excellence program, which lays out the requirements for a surgeon and a facility to perform these surgeries in a way that minimizes the risk.

But right now, this study will serve as the fuel for insurance denials and perhaps cause some payers to reconsider their coverage.

I’m not happy about this study – can’t you tell? It’s a combination of irresponsible data analysis coupled with a truly appalling tale of surgical skill and aftercare.

3 thoughts on “New report on bariatric surgery complications

  1. valarie says:

    not for nothing, but patient compliance failure rates are used in other statistics as well. For instance, when dispensing birth control we stressed that a particular method’s success rate was x% when used consistently and correctly, or x% overall accounting for actual use, wrong and right use included. If a certain number of people will predictably behave in a way that supports this failure statistic, it makes sense to include it, although I agree the source of the statistic–ie, patient failure to comply–should be disclosed.

  2. Jane says:

    Absolutely agree, valarie. The issue of patient compliance with post-surgery living is essential. And long-term education and follow-up are sadly lacking for us.

    My biggest gripe, however, is the classification of these compliance issues with things like infection, anastomosis complications, and hernia. They’re completely different issues and need to be treated as such.

  3. Melissa says:

    Another study would be better suited for the “faults” for the complications, but the study above was about the cost realities of the post-op world. The authors were correct to including dumping syndrome since that is a possible complication of the surgery – not something that happens to people who haven’t had this type of surgery. We also can’t assume that other complications weren’t also due to patient error (i.e. ignoring an infection too long).

    Valarie is correct – we can’t ignore reality and assume that patients are going to be 100% perfect. We are humans, not robots. Whatever “diet” or lifestyle we are following, very few are 100% – 100% of the time so why expect that with WLS patients?

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