Highest Risk Patients Often Not Getting Surgery?

surgery_needIt makes sense that important medical treatments like surgery would go to the people who are in most need of them. However, many of the people who most need bariatric surgery aren’t getting it, according to new research published in the peer-reviewed journal, JAMA Surgery.  Currently, body mass index (BMI), an estimate of obesity using height and weight, is used as one of the main factors for determining if a patient should have bariatric surgery. However, after studying more than 15,000 bariatric surgery patient records from the UK, researchers from the University of Alberta concluded that size alone is not a good way to prioritize who should get surgery. Rather, they found that in obese patients, sex, smoking status, and diabetes accurately predicted the highest risk of death.  “If you’re a male smoker and have diabetes, you have the highest risk,” said study author, Arya Sharma.

According to the World Health Organization, 347 million people around the world have diabetes. When the study authors looked at their data, they found having diabetes was the strongest predictor of death; Obese patients with diabetes were more than twice as likely to die compared to obese patients without diabetes. Smoking increased risk of death 1.6 times, and being male increased risk 1.5 times.

The researchers developed a simple prediction rule for doctors to use to calculate the risk of death in patients eligible for bariatric surgery by inputting age, sex, smoking status and whether a patient has diabetes.  For example, the calculator would show that a middle-aged man who smokes and has diabetes has a risk of dying in 10 years that is 10 times higher than a young, female, non-smoker who doesn’t have diabetes–regardless of BMI.  “A tool like this can be very useful to demonstrate to patients, in more concrete manner, the risk of early death.  The more information that a patient has, the more informed decision they can make regarding their healthcare,” said Dr. Toby Broussard, weight loss surgeon in Oklahoma.

Worldwide, about 350,000 bariatric surgeries are performed each year, and the majority of them are currently performed on women.  The researchers hope their research will serve as a valuable tool in ensuring that the patients who need surgery the most are not being overlooked.

Related Reading: Surgery Superior for Obese Patients with Diabetes, Studies Say

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