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new scoring system predict risks of bariatric surgery
SAN FRANCISCO, June 29, 2006 – Researchers have developed a new scoring system that may help patients with morbid obesity better understand how much individual risk they face from bariatric surgery. The scoring system was presented today at the 23rd Annual Meeting of the American Society for Bariatric Surgery (ASBS). 31-12-2006
 Researchers based the clinical scoring system on an analysis of 2,075 consecutive patients who had gastric bypass surgery at Virginia Commonwealth University from 1995 to 2004. The overall 90-day mortality rate of these patients was about 1.5 percent. However, when the new scoring system was applied it showed patients fell into three groups and had significantly different rates of risk.
Patients in the lowest risk group had a mortality risk of 0.31 percent (3 out of 957 patients); the medium risk group had a mortality rate of 1.91 percent (19/999); the highest risk group had a mortality risk of 7.56 percent (9/119).
“This is the first scoring system of its kind that suggests we can better determine a patient’s individual risk of dying from complications of obesity surgery prior to them ever setting foot in the operating room,” said Eric J. DeMaria, MD, lead author and Chief of Endosurgery and Vice Chairman of Network General Surgery at Duke University Medical Center. “If the scoring system is adopted and validated, patients and their doctors could make decisions based on individual risk factors rather than national averages.”
The clinical scoring system incorporated five independent variables including: body mass index (BMI) equal to or greater than 50; male gender; hypertension; risk factors that increase the complication of pulmonary embolus; and age (people 45 or older) to determine relative risk.
Each variable equaled one point and overall scores ranged between 0 (least risk) to 5 (highest risk) for each patient. The scores were then further divided into three risk classes: A (Scores 0 – 1), B (Scores
2 – 3) and C (Scores 4 – 5).
“Those patients with the highest risk scores for surgery may also be at the highest risk for premature death from morbid obesity,” said Dr. Demaria. “The risk scoring system may suggest strategies that could reduce the risk of surgery for many patients and allow them to get the treatment they need for morbid obesity.”
As with any surgery, the risks and benefits should be carefully considered by the surgeon, the patient and the patient’s family. According to the ASBS, the average mortality rate in an ASBS Center of Excellence is 0.3 percent after 90 days based on an analysis of 33,000 patients. A 2004 study published in the Journal of the American Medical Association (JAMA)* showed 0.1% mortality for laparoscopic adjustable gastric band (LAGB) patients, 0.5% mortality for gastric bypass patients and 1% mortality for biliopancreatic diversion (BPD) and duodenal switch (DS) patients.
In 2005, the ASBS reported that an estimated 170,000 people in the U.S. had bariatric surgery. About 15 million or 1 in 50, adults in the U.S. have morbid obesity, which is associated with numerous other diseases and conditions including Type 2 diabetes, heart disease, sleep apnea, hypertension, asthma, cancer joint problems and infertility. The direct and indirect costs to the healthcare system associated with obesity are about $117 billion annually.
The ASBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information about the ASBS visit www.asbs.org.
* Buchwald H, Avidor Y, Braunwald E, Jensen M, Pories W, Fahrbach K, Schoelles, Bariatric surgery: A systematic review and meta-analysis. JAMA, 2004,292:1724-57.Source: www.asbs.org.
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