Sunday, March 20, 2011

Did you know that Diabetes is a risk factor for complications in Gastric Bypass


Did you know that Diabetes is a risk factor for complications in Gastric Bypass?
Spectrum and Risk Factors of Complications After Gastric Bypass This Article •Abstract •PDF •Send to a friend •Save in My Folder •Save to citation manager •Permissions Citing Articles •Citation map •Citing articles on HighWire •Citing articles on ISI (5) •Contact me when this article is cited Related Content •Related article •Similar articles in this journal Topic Collections •Public Health •Obesity •Bariatric Surgery •Gastrointestinal/ Upper Foregut •Alert me on articles by topic Social Bookmarking Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati What's this? Spectrum and Risk Factors of Complications After Gastric Bypass Guilherme M. Campos, MD, PhD; Ruxandra Ciovica, MD; Stanley J. Rogers, MD; Andrew M. Posselt, MD, PhD; Eric Vittinghoff, PhD; Mark Takata, MD; John P. Cello, MD Arch Surg. 2007;142(10):969-975. ABSTRACT Objective To study the spectrum of and risk factors for complications after gastric bypass (GBP). Design Prospective cohort study. Setting Academic tertiary referral center. Patients All morbidly obese patients who underwent open or laparoscopic GBP between January 2003 and December 2006. Main Outcome Measures Complications were stratified by grade: grade I, only bedside procedure; grade II, therapeutic intervention but without lasting disability; grade III, irreversible deficits; and grade IV, death. Data were analyzed using logistic regression to identify independent risk factors of complications after GBP. Predictors investigated were age, race, sex, marital and insurance status, body mass index, obesity-associated comorbidities, American Society of Anesthesiologists Physical Status Class, operating room time, open or laparoscopic approach, and surgeon experience. Results Of the 404 morbidly obese patients who underwent consecutive open (n = 72) or laparoscopic (n = 332) GBP, 74 (18.3%) experienced 107 complications. Grade I and II complications were more frequent after open GBP (grade I, 19.4% after open vs 3.9% after laparoscopic operations, P < .001; grade II, 20.8% after open vs 8.4% after laparoscopic operations, P < .001), and 55% were wound related. Grades III and IV complications occurred in only 4 patients (1%), and frequency was similar for open and laparoscopic cases. Three factors were independently predictive of complications: diabetes mellitus (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3; P = .02), early surgeon experience (OR, 2.5; 95% CI, 1.4-4.2; P = .001), and open approach (OR, 3.9; 95% CI, 2.1-7.3; P < .001). Conclusions Complications occurred in 18.3% of patients, but 95% were treated without leading to lasting disability. Presence of diabetes, early surgeon experience, and an open approach are risk factors of complications. There is also 58% increased chance of suicide among GB recipients. NIH complication rate from 20-40% New Jersey study 10% surgery for bowel obstruction Acute Kidney function problems 8.5%
Diabetes - 4 Answers
Random Answers, Critics, Comments, Opinions :
1 :
I'm not suprised..DM complicates and is a risk factor for many things
2 :
The one response states the truth quite clearly - diabetes is a risk factor for many things. Physicians take into account risk versus benefit. It is a risk for you to drive to work - but the benefit outweighs the risk because the risk is small. With diabetes the benefits of gastric by-pass and gastric lap-banding are tremendous. A reduction in adverse health consequences - most especially cardiovascular events - improved quality of life - and perhaps most importantly a longer life. There are risks and the risks are often difficult to establish with precision. Overall - however - the risks are quite small. Physicians tend to report risks in one of two manners - hazards ratio and absolute numbers. Hazards ratios (or odds ratios) are too often misleading. For example a study might report a hazards ratio of 1.2 meaning that the risk for a diabetic is 1.2 times that of a non-diabetic. That may sound significant but in clinical terms it is small. When studies provide absolute numbers the risk is easier to understand and just how small the risk is may be more easily seen. The increased risk of diabetics undergoing gastric by-pass or gastric lap banding is overall less than 1%. You report a hail-storm of numbers but even physicians are typically not able to determine the statistical analysis of a study - so expecting readers in this forum to make sense of it is not realistic. Multiple medical studies have determined that only about 20% of physicians are able to understand the statistical analysis of any given study. Having taught 'Interpretation of the Medical Literature' and having written a book on this subject I would suggest that the estimate of 20% is high. The 20% figure was obtained by asking physicians if they felt that they were able to understand the literature not actually having them read and comment on articles. You raise too many different statistical techniques to comment on all of them. I am not certain if you are trying to educate readers that gastric by-pass and gastric lap-banding are safe or if you are trying to state the opposite. The medical literature is clear and consistent in its conclusion that the benefits of surgery far out-weight any risks for diabetic questions. If you have specific questions about the statistics that you have reported please email me at johnerussomd@jhu.edu. I wish you the very best of health and may God Bless.
3 :
There have been like a million gastric bypass patients since 1980 and you can only find testimonials from people 1 or 2 years into the mess. This surgery is no good long term, It GIVES YOU MALABSORPTION OF VITAMINS AND MINERALS WHICH INEVITABLY WILL SHORTEN YOUR LIFE, plus all the kidney, bowel obstruction, strictures, seizures out of electrolyte imbalances etc... It's no picnic to have this done I WOULD NOT WISH THIS SURGERY ON MY WORST ENEMY.
4 :
Diabetes complicates everything. Even the smallest cut takes a longer time to heal. That's why it's so important to be "pro-active", be careful about what we eat (hate the word diet) and we must exercise and move.





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Posted by Diabetes Melitus at 1:42 PM