Panel to review obesity surgery programs
State cites worries over deaths during or after procedures
Citing serious worries about patients who have died during or after obesity surgery, the state health department is convening an expert panel to review the quality of hospital bariatric surgery programs and recommend improvements.
"Because of the dramatic increase in demand for this surgery and the number of deaths, we have enough concern that we need to get the experts together and look at whether there's opportunity for improvement," said Nancy Ridley, an assistant commissioner of public health and head of the Betsy Lehman Center for Patient Safety and Medical Error Reduction. "Many people who are planning to have this surgery are concerned. Parents are concerned because it's being hyped toward kids. It's not something that's going away. There are questions and people want answers."
Ridley said she does not know of any other states that have undertaken systematic statewide reviews of hospital obesity surgery programs.
The most recent known death occurred last week at Beth Israel Deaconess Medical Center, when Howard Reid, 37, of Dorchester, went into cardiac arrest immediately after surgery Tuesday. After spending two days on life support, he died on Thursday. Last fall, two patients died after gastric bypass surgery, one at Brigham and Women's Hospital in Boston and another at Roger Williams Medical Center in Providence.
Massachusetts hospitals, patients, families and staff have reported seven deaths or complications during or after obesity surgery to public health officials since 1998. But four of the seven incidents occurred in the past year, worrying health officials that deaths and complications are rising. Of the four incidents reported since January 2003, three involved a patient dying. These patients included Reid, Ann Marie Simonelli, 37, who died in October at the Brigham, and a third patient who died after surgery at Boston Medical Center. Health officials would not release details about that death.
One in every 100 to 300 patients dies from complications from obesity surgery, and another 10 to 20 percent experience surgery-related infections and other problems, doctors said. Many of these patients have medical conditions like diabetes that make surgery more risky. But the number of patients undergoing some type of bariatric surgery has skyrocketed -- to 103,200 last year from 23,100 in 1997.
Ridley said the department doesn't know if deaths increased because more patients are having the surgery, because hospitals are more vigilant about reporting problems, or because of other factors. As more hospitals open surgery programs, one recurring question is whether they are adhering to the highest standards in the operating room, or in evaluating which patients are appropriate for surgery. She said the panel will try to find an answer.
The department has not appointed panel members, but it will include surgeons, nutritionists and patient safety experts.
Ridley said the group will study patients who did well after surgery and those who experienced complications, and try to identify factors that played a role in these outcomes. The group also will decide whether the department should adopt regulations restricting obesity surgery to hospitals that perform a high number of procedures or in some other way regulate the procedure as it does with cardiac surgery. They will review all types of bariatric surgery, including stomach-stapling and the Lap-Band procedure, during which the surgeon places a silicone band around the patient's stomach to restrict the amount of food he can eat.
The Massachusetts health department has implemented similar initiatives for cardiac surgery and for maternal mortality.
A task force in 2000 reviewed the medical charts of 88 women who died during or shortly after pregnancy in 1995 through 1998. The group found that 18 deaths were preventable through better medical practice. The study led to "best practice" recommendations for hospitals, Ridley said.
The department still is collecting data on cardiac surgery, but will publish mortality statistics for individual hospitals starting in the spring, she said. The department could end up requiring improvements at poor performing hospitals or referring doctors with high mortality rates to the Board of Registration in Medicine for investigation.
Liz Kowalczyk can be reached at kowalczyk@globe.com.
