Surgery News - August 2007 - (Page 7)

AUGUST 2007 • SURGERY NEWS GENERAL SURGERY Bariatric Surgery Yields Long-Term Cost Savings tiveness of this procedure. Some of the studies that perform modeled cost analyses use estimated costs for their analyses. S A N D I E G O — Over time, the health They would require more accurate, direct care costs for patients who undergo cost data sourced from the payer to imbariatric surgery appear to be lower than prove this type of research.” She and her associates studthose for patients who underied 37 patients who underwent go medical treatment for the bariatric surgery at the medical condition, results from a small center between 2000 and 2004. pilot study demonstrated. The control group consisted of The study is unique because 30 patients who received medthose who participated were ical treatment for obesity at the enrolled in a health system– center during the same period. owned health care plan that Patients were matched for age, shares its costs with clinical gender, body mass index, and data, Dr. Anita P. Courcoulas Charlson score, and were folThis pilot work said at the annual meeting of the American Society for shows the value of lowed for 3 years. At baseline, the mean age of partnering with our Bariatric Surgery. patients was about 48 years “Payers are reluctant to covpayers to identify and most (96%) were female. er bariatric surgery,” said Dr. cost savings for Their mean body mass index Courcoulas, an ACS Fellow bariatric surgery. was 48 kg/m2 and the mean who practices bariatric surgery DR. COURCOULAS and general surgery at the UniCharlson score was 0.58. versity of Pittsburgh Medical Center. “One Dr. Courcoulas reported that at 3 years reason is that there is a relative lack of data of follow-up the total medical cost per paavailable to determine the true cost effec- tient in the bariatric surgery group was BY DOUG BRUNK Else vier Global Medical Ne ws $16,013.35, compared with $22,282.20 per patient in the control group. For patients in the surgery group, this translated into a medical cost savings of 39%. At 3 years of follow-up, the total pharmacy cost per patient was $3,916.22 in the surgery group, compared with $7,479.44 in the control group. “There is a trend of increased [pharmacy cost] in the control group, but these [numbers] were not significant due to small sample sizes and the variability,” she said. She noted that the use of medications for diabetes by the bariatric surgery patients appeared to decrease over time, “but there was some increase in [use of] other medications.” The study is a “pilot work that demonstrates the feasibility and value of partnering with our payers to try to identify where we can show cost savings for bariatric surgery,” Dr. Courcoulas emphasized. “In the future we hope to present larger sample sizes with much more long-term prospective follow-up, because it appears to take longer than 3 years to show cost sav- ings. Our aim is to identify clinical predictors of high risk and high cost outliers. But the hope is that results like these—using actual direct cost data—may help to inform future model costs analyses.” ■ Total U.S. Health Care Cost per Patient at 3-Year Follow-Up $22,282 $16,013 ELSEVIER GLOBAL MEDICAL NEWS Bariatric surgery (n = 37) Control (n = 30) Note: Patients in the control group received medical treatment for obesity. Source: Dr. Courcoulas Laparoscopic Gastric Banding Deemed Safe, Effective for Teens BY MITCHEL L. ZOLER Diabetes Resolved After Bariatric Surgery C H I C A G O — Two years after bariatric surgery, 73% of patients had remission of their type 2 diabetes, compared with 15% of control patients who did not receive the surgery, according to the findings of a randomized controlled trial. Observational reports have already suggested that the weight loss induced by bariatric surgery can resolve type 2 diabetes in many patients (70%80%). But none have been controlled, prospective trials, said Dr. John B. Dixon of the centre for obesity research and education at Monash University, Melbourne, Australia. Dr. Dixon presented his study in a poster at the annual scientific sessions of the American Diabetes Association. “This adds meat to what we’ve already known,” he said in an interview. The study enrolled 30 patients, ages 20 to 60, in each group, all of whom had a body mass index (BMI) greater than 30 kg/m2 and less than 40 kg/m2. Of the 30 randomized to surgery, one patient withdrew prior to surgery, and the rest were evaluated for the full 2 years. Patients in the surgery group received laparoscopic, adjustable gastric banding. Patients in the control group received the best available management, including medication if deemed appropriate; four patients in the control group withdrew. At 2 years, patients who had surgery achieved a mean weight loss of 21% of body weight, compared with 2% for those who did not have surgery. Patients in the surgery group lost a mean of 65% of their excess body weight, compared with 6% in the control group. At baseline, 23% of the surgically treated patients had a hemoglobin A1c level below 7%, and that percentage rose to 87% at 2 years. In the control group, 37% had an HbA1c level below 7% at baseline, and that rose to 50% at 2 years. By the trial’s end, 10% of the surgically treated patients were using metformin, versus more than 90% of the controls. The surgical group had greater improvements in triglyceride levels and HDL cholesterol levels as well. Adverse events in the surgical group included one patient with a superficial wound infection, two patients who needed nonurgent revision, and one patient who had the band removed after 15 days because of persistent regurgitation. Further analysis showed that it was the weight loss that accounted for almost all of the difference in the remission rates of diabetes between the two groups, such that a 10% weight loss provided an 85% sensitivity and an 86% specificity for remission, Dr. Dixon said. —Timothy F. Kirn Else vier Global Medical Ne ws O R L A N D O — Sustained weight loss with few complications was achieved after gastric banding placed laparoscopically, according to a single-center series of 73 adolescents after 2 years of follow-up. “Weight loss with laparoscopic adjustable gastric banding led to excellent resolution of important comorbidities,” Dr. Evan P. Nadler and his associates reported in a poster at the annual meeting of the American Pediatric Surgical Association. “The complication rate in our pediatric patients was about the same as the rate in adults, and the morbidity is milder than with gastric bypass. Concerns about compliance by adolescents [who undergo gastric banding] seem unfounded. We believe that laparoscopic adjustable gastric banding is ideally suited to adolescents, and in our opinion it’s the optimal surgical option for pediatric patients with morbid obesity,” they said in their poster. Dr. Nadler and his associates at New York University, New York, began performing laparoscopic gastric banding on morbidly obese teenagers aged 13-17 in September 2001. The average age of their first 73 patients was 15.8 years. Of these patients, 54 were girls, and their average preoperative body mass index (kg/m2) was 48. During the first 6 months following gastric banding, mean BMI dropped to 40 (with follow-up in 53 patients), and by 1 year after surgery, BMI averaged 34 (with follow-up on 47 patients). By 1 year after surgery, treated patients had lost an average of 57% of their excess weight. These weight losses were maintained in the patients followed for longer than 1 year. After 18 months, mean BMI remained at 34 (30 patients followed), and after 2 years the mean BMI was 32 (16 patients followed). At 2 years of follow-up, the average amount lost was 61% of excess weight at baseline, reported Dr. Nadler, director of minimally invasive pediatric surgery at NYU. Of the 73 teenagers who received a gastric band, An access tube is threaded through a slot that enables the band to wrap around the stomach. two later had their bands removed, one because of band slippage and the other because of gastric perforation. An additional five patients with slipped bands had them repositioned with a repeat procedure. The most common complications resulted from nutritional deficits: mild hair loss (14 patients), iron deficiency (13), and vitamin D deficiency (4). These patients received nutritional counseling and supplements. Other complications included three cases of hiatal hernia, which were repaired laparoscopically; three cases of gastroesophageal reflux, which were controlled medically; and one case each of wound infection, symptomatic nephrolithiasis, symptomatic cholelithiasis, and asymptomatic cholelithiasis. In the first year after band placement, patients had an average of 10 office visits and required an average of six band adjustments. In addition, 21 of the patients were more intensively evaluated and followed as part of a study for the Food and Drug Administration. These patients had 51 identified, obesity-related comorbidities at baseline. At 1 year after gastric banding, 35 of the comorbidities had completely resolved, 9 had improved, 5 showed no change, and 2 had worsened. ■ COURTESY OR-LIVE.COM

Table of Contents Feed for the Digital Edition of Surgery News - August 2007

Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.