Navigation Links
Government restrictions on weight loss surgeries limit access for poor, underinsured patients
Date:10/30/2007

DALLAS Oct. 30, 2007 Thresholds limiting bariatric surgeries to high-volume centers disproportionately restrict access for poor and underinsured patients, populations which are among the most in need of them, an analysis led by UT Southwestern Medical Center researchers shows.

Government-imposed restrictions currently mandate a 125-case annual threshold for facilities permitted to perform bariatric surgeries under Medicare and Medicaid because some studies have identified better outcomes for centers performing large volumes of bariatric surgeries. But most bariatric surgeries for the poor about 60 percent are performed in low-volume centers.

Restricting surgeries to high-volume centers has the effect of limiting bariatric surgery as an option for many poor and underinsured who rely on Medicare and Medicaid, said Dr. Edward Livingston, senior author of the study appearing in the October edition of Archives of Surgery. This is a population that stands to gain the most from bariatric surgery.

Dr. Livingston is chairman of gastrointestinal and endocrine surgery at UT Southwestern and chairman of the Veterans Administration Central Office Bariatric Surgery Work Group.

Nearly three quarters of hospitals offering bariatric surgery are considered low-volume facilities under the 125-case threshold, thereby leaving few centers available for impoverished populations.

Yet low-income patients, particularly those in rural areas, may not be able to travel to the limited number of high-volume centers due to costs such as gas, access to public transportation or personal vehicles, or health matters that limit their travel, Dr. Livingston said.

Such restrictions further limit medical expertise for morbidly obese patients by reducing the number of hospitals well-equipped and properly staffed to handle the special needs of these cases. Regionalization results in the global reduction of experience in managing obese patients at a time when obesity is rapidly increasing in the population, the study notes.

Researchers led by Dr. Livingston reviewed 51,000 records involving weight-loss surgeries carried out in nearly 750 U.S. hospitals over a three-year span (2001-2003).

Researchers found that statistical sampling methods used in the handful of studies favoring high-volume centers skewed results by amplifying a small number of excess deaths in very low-volume facilities. Databases used in the studies typically had sparse information on individual patients backgrounds. Accounting for the specific health risks of patients, however, often eliminates the advantages seen for high-volume centers, the analysis showed.

Low-volume centers tend to accept higher-risk patients, while high-volume centers gravitate toward more lower-risk patients, the researchers found. In either case, the overall risk was small, as the survival rate at low-income centers was 99.66 percent.

Restricting cases to high-volume centers isnt going to have a profound effect in limiting the number of deaths, but would have a profound effect in limiting accessibility to bariatric surgery, Dr. Livingston said. More likely, the surgeons cumulative experience and access to multidisciplinary teams of doctors available before, during and after surgery result in better outcomes.

Rather than limiting procedures to high-volume centers, bariatric programs should be judged by risk-adjusted outcomes, such as the National Surgical Quality Improvement Program, he said.

Thats important because studies indicate that non-surgical therapies for morbidly obese patients are uniformly unsuccessful for sustained weight loss. In addition, despite increasing numbers of bariatric surgeries performed, they are still dwarfed by the eligible population. The Centers for Disease Control and Prevention estimates that nearly one-third of adult Americans more than 60 million people are obese, with nearly 5 percent of adults classified as extremely obese.

Bariatric surgeries, which are usually reserved for those more than 100 pounds overweight, can help not only with weight, but related health problems. Obese adults are at increased risk of diabetes, hypertension, stroke and even some cancers.

Weight-loss surgeries have become more common as obesity has increased, with more than 140,000 gastric bypass procedures now performed in the U.S. annually.

UT Southwesterns Center for Minimally Invasive Surgery is one of only seven facilities in North America, and the only one in Texas, to be accredited by the American College of Surgeons. It has been named a Bariatric Surgery Center of Excellence by the American Society for Bariatric Surgery.

Surgeons at UT Southwestern performed the first laparoscopic gastric bypass surgery in Texas in 1999 and were the first in the Dallas area approved to perform the Lap Band procedure in 2001. UT Southwesterns bariatric specialists have performed approximately 4,000 procedures and have trained more than 100 surgeons from across the U.S.

Other UT Southwestern researchers involved in the study were Dr. Linda Hynan, associate professor of clinical sciences, and Alan Elliott, faculty associate in clinical sciences. Scientists from the University of California, Los Angeles department of biomathematics also contributed.


'/>"/>

Contact: Russell Rian
russell.rian@utsouthwestern.edu
214-648-3404
UT Southwestern Medical Center  
Source:Eurekalert

Related medicine news :

1. The Indian Government has given the nod to conduct Human volunteer trials inorder to develop preventive AIDS vaccines
2. The Central Government of India had issued a list of approved ingredients for use in ayurvedic, siddha, unani drugs
3. Tanzanian Government Sanctions $20 Million For AIDS Arug
4. Government Organisation Proposes Strict Guidelines For SubStandard Medical Devices
5. Indian Government warns Gujarat regarding possibility of bird flu
6. Indian Government Sets Up Task Force For Avian flu
7. Delhi Government To Interlink All Major Hospitals Through e-Governance
8. Kerala Government is in High Alert for Bird Flu
9. Philippines Government prepares to counter bird flu
10. Government Takes Tough Stand Against Falling Sex Ratio
11. Avian Influenza: Government to set up expert committee
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Government restrictions on weight loss surgeries limit access for poor, underinsured patients
(Date:2/10/2016)... ... February 10, 2016 , ... 10 Best Water ... were three leading bottled water brand owners that topped the list as a result ... and optimize conversion. The premier brand was Tibet 5100, a top notch water company ...
(Date:2/10/2016)... ... ... Ongoing news of the ravages of traumatic brain injury (TBI) among former ... takes a closer look at cases of TBI being managed by their members. The ... the aging population, and identifies the challenges associated with their care. , During the ...
(Date:2/10/2016)... ... February 10, 2016 , ... Gout is like no other joint pain. ... often severe, with intense swelling and redness. It is triggered by the crystallization of ... adults are the most susceptible, according to the February 2016 issue of Harvard Men's ...
(Date:2/10/2016)... ... February 10, 2016 , ... AHRA: ... winner and inspirational speaker Jan Fox will serve as keynote speaker at the ... provide participants with tools to more effectively communicate with their own organizational staff ...
(Date:2/10/2016)... ... February 10, 2016 , ... A national ergonomics pioneer ... Expo event March 9-11, 2016. Hosted by Ohio's Bureau of Worker's Compensation, the ... the longest running and largest worker's compensation event in Ohio, organizers of the ...
Breaking Medicine News(10 mins):
(Date:2/10/2016)... Fla. , Feb. 10, 2016 CSI ... today with the launch of the Specialty Pharmacy Podcast. ... an industry-first, aimed at providing real-world education, discussion and ... --> --> The ... and CEO of CSI Specialty Group Suzette DiMascio, CHE, ...
(Date:2/10/2016)... YORK , Feb. 10, 2016 Immune ... biopharmaceutical company, announced today that it has filed a ... Leukemia and other cancers. --> ... treating cancer by administration of Ceplene (histamine dihydrochloride) in ... provides methods of predicting the efficacy of Ceplene and ...
(Date:2/10/2016)... Feb. 10, 2016  The ALS Association, in partnership with ... Challenge to generate a biomarker to track TDP43 aggregation. The ... to a $1 million investment. --> ... that affects nerve cells in the brain and the spinal ... and control muscle movement, which often leads to total paralysis ...
Breaking Medicine Technology: