BARIATRIC OPTIONS: Weight-loss surgery becoming safer, Michigan registry shows
Bariatric surgery, a $150-million-a-year industry in Michigan, is safer than it was in 2000. Deaths and serious complications are rare, the first year of data in a Michigan registry show.
Other findings: Weight loss one year after surgery varies by procedure and some surgeries are better than others at helping people stop taking medicines, from insulin and oral drugs for diabetes to blood pressure-reducing drugs.
The data come from the Michigan Bariatric Surgery Collaborative, the largest database of its kind in the country. Funded by Blue Cross Blue Shield of Michigan, it aims to makes bariatric surgery safer and possibly less costly.
Dr. John Birkmeyer, chief of bariatric surgery at the University of Michigan, says Michigan's bariatric industry is growing.
His $150-million-a-year estimate is based on 5,000 bariatric procedures performed in Michigan last year, at an average cost of $30,000. Complications from bariatric surgery account for $30 million, or 20% of the cost, Birkmeyer said.
The registry presented its first one-year data on June 5 to surgeons at the 22 Michigan hospitals that participate in the bariatric project at a meeting at U-M. The first year of data is based on 332 patients. More than 5,000 people now are part of the registry since it began tracking all bariatric surgery results in Michigan in July 2006.
Lap-Band is safest
Information collected for the registry found that Lap-Band, the most common bariatric procedure, involving the insertion of a silicone band to tighten the upper stomach and limit food intake, is the safest procedure, but patients lost an average of only 57 pounds in their first year after the operation, compared with the 102 pounds people achieved after minimally invasive gastric bypass surgery and 118 pounds lost after open, or conventional gastric bypass, the data show.
Lap-Band patients also were more likely than patients undergoing the two other surgeries to need oral diabetes, blood pressure and diuretic medicines one year after surgery, according to the registry.
Minimally invasive gastric bypass surgery, the second most common procedure, had the highest rates of reoperations, extended hospital stays, deaths and other so-called adverse events, the registry shows. Still, its rates of life-threatening events were only 0.5%, significantly lower than rates of about 2% in 2000, Birkmeyer said.
Overall, 12 Michigan patients died from problems associated with bariatric surgery between July 2006, when the registry began enrolling patients, and June 1.
Of those, seven had minimally invasive gastric bypass surgery, four had open gastric bypass and one underwent Lap-Band. The most common cause of death was wound leakages, followed by infections. By contrast, death rates from all procedures were about 2% in 2000, Birkmeyer said, citing national statistics before the Michigan registry began.
Because the statistics are the first in a three-year project, "it's premature to draw any conclusions" about which operation is best or safest, said Dr. David Share, senior associate medical director for health care quality at Blue Cross, which gives a $700,000 grant each year to support the project.
As an incentive, Blue Cross gives as much as $200,000 a year in additional reimbursements to hospitals participating in the registry that lower complication rates.
With one in five Americans considered obese -- including nearly 2 out of 3 Michiganders -- bariatric surgery increasingly is an option for people who have tried unsuccessfully to lose weight for years, as well as a growing choice among heavier patients with Type 2, or adult-onset diabetes.
Patients may spend months trying to decide to have surgery and getting insurance reimbursement.
"If I had this information earlier, I would have done it a lot sooner," said Charla White, 47, of Whitmore Lake, who has lost 100 pounds since her Oct. 16, 2006 minimally invasive gastric bypass surgery at the University of Michigan.
"I had heard all the horror stories and none of the good stories," said White, a college events coordinator and a woman who has struggled with weight issues most of her life. Her M-Care insurance paid for the surgery, after she was turned down by Blue Care Network, her previous insurer.
"The most exciting thing that has happened to me in the last year is that a guy opened the door and smiled at me when I was going to a restaurant," White said. "I now can walk between two parked cars and not get my clothes dirty."
Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com.
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