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.