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Medicare News
Bariatric Surgery Appears as Safe for Selected
Medicare Patients as Other Adults, Despite Deaths
Study says surgery should not be denied solely based
on age or Medicare status
June 18, 2007 When Medicare began covering
bariatric surgery for severe obesity, there was an alarming number of
deaths reported. A new study, says, however, that complications after
the surgery appear to be similar between Medicare recipients and
non-recipients. They also conclude problems are the same for those under
age 60 as for those passed 60.
According to this study in the June issue of
Archives of Surgery, one of the JAMA/Archives journals, Obesity has
become the leading cause of preventable death in the United States.
Rates of obesity have continued to climb in the
last decade across all age groups. Surgery for morbid obesity is
currently the most effective treatment.
The success of bariatric surgery has expanded the
treatment of morbid (severe) obesity and its conditions for patient
populations that had not previously been served. Medicare has recently
begun covering bariatric surgery although significant death rates have
been reported in Medicare patients undergoing surgery.
Peter T. Hallowell, M.D., and colleagues of
University Hospitals Case Medical Center and Case Western Reserve
University School of Medicine, Cleveland, reviewed the cases of 892
patients who had gastric bypass surgery from 1998 to 2006.
The patients were divided into four groups.
Group one, 46 patients age 60 to 66 years was
compared with group two, 846 patients age 18 to 59 years.
Group three, 31 Medicare recipients (age 31 to 66),
was compared with group four, 861 non-Medicare recipients (age 18 to
64).
The age, sex and body mass index of each patient
were documented as well as time spent in the operating room, length of
stay, other illnesses and complications (including death).
When comparing older and younger patients,
male-female ratios and BMIs were similar and length of stay was a
half-day longer for group one. The older group spent an average of 17
minutes less in the operating room than the younger group.
There was no statistically significant difference
found between the two groups for any postoperative complication or
death.
No mortality was seen in the older group (group
one) at 30 days, 90 days or one year. Three deaths occurred within 30
days in the younger group (group two) with one additional death within
one year, the authors note.
When comparing Medicare and non-Medicare patients,
group three (Medicare patients) had a greater average BMI of 56 and
spent an average of 14 minutes longer in the operating room.
Medicare patients also spent an average of a
day-and-a-half longer in the hospital. There was no significant
difference between the two groups for any complication or death after
surgery. No Medicare patients died at 30 days, 90 days or one year.
Three non-Medicare patients died within 30 days and one additional
patient died within one year.
Bariatric surgery can be performed in carefully
selected Medicare recipients and patients 60 years or older with
acceptable morbidity and mortality, the authors conclude.
We believe that these results reflect careful
patient selection, intensive preoperative education and expert operative
and perioperative management. Our results indicate that bariatric
surgery should not be denied solely based on age or Medicare status.
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