The 30-day mortality from the surgery has ranged from almost zero to as high as 2 percent in some studies, but it can be higher for some selected populations, the report said.
"The patients who benefit the most are younger patients who have a lower risk of dying from the surgery and a higher BMI," Schauer said. "The patients who benefit the least are older patients with a higher surgical risk because of a combination of age and comorbidities [other illnesses]."
Their model does not calculate the risk added by specific comorbidities, such as coronary disease, he said. "We are working on that for the next generation of models," Schauer said.
The most recent data used comes from 2007, and there is also reason to believe that the surgical risk has decreased since then, Schauer said. "That is something we are working on, updating the model as it becomes available," he said.
Dr. T. Karl Byrne, professor of surgery and director of bariatric surgery at the Medical University of South Carolina, said he would like to see more information on the cost benefits and health improvements associated with gastric bypass.
Every diabetic costs the health care system $13,000 a year, Byrne said. If you are diabetic and have bariatric surgery, in six months your diabetes goes away. So there is more to it than just life years obtained. There is a huge cost issue that is not addressed in these studies, and bariatric surgery should cost the health care system less in the long term, he said.
A second report in the same issue of the journal reported a marked change in the sites doing bariatric surgery after the federal government approved Medicare and Medicaid payment for the procedure in February 2006.
That coverage required that surge
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