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:4/28/2016)... BROOKLINE, MA (PRWEB) , ... April 28, 2016 , ... ... his revolutionary work in the emerging field of biomechatronics, technology that marries human physiology ... the MIT Media Lab. He is also the Founder of BionX , a ...
(Date:4/28/2016)... ... April 28, 2016 , ... ... Management solutions, announces today the availability of its latest software release, NetZoomDC ... capacity management and optimization, providing new analytical capabilities that assess complex capacity ...
(Date:4/28/2016)... ... 28, 2016 , ... One way to ignore solid evidence is to dismiss ... we toss the baby out with the bathwater when we ignore all studies because ... studies and otherwise making better use of education policy research. , “When readers heed ...
(Date:4/28/2016)... ... April 28, 2016 , ... USA Medical Card reminds us that May is National ... stroke is the fourth leading cause of death in the United States; someone has one ... quarter of them in individuals under 65 years old. A stroke is when blood ...
(Date:4/28/2016)... ... April 28, 2016 , ... Anzu®, ... announced a new Residency Education & Collaboration Platform for hospitals and medical ... and a host of collaboration tools designed to improve patient outcomes through ...
Breaking Medicine News(10 mins):
(Date:4/28/2016)... 2016   Click here for supplemental information ... DPLO), the nation,s largest independent specialty pharmacy, announced ... to acquire Valley Campus Pharmacy, Inc., doing business ... specialty pharmacy that provides individualized patient care, based ... In 2015, TNH generated approximately $400 million in ...
(Date:4/28/2016)... 2016  While Abbott,s announced purchase of St. ... repair and stent business, healthcare research firm Kalorama ... firmly into patient monitoring.  Kalorama said that patient ... areas, with double-digit growth expected the next 5 ... Remote Patient Monitoring . Abbott Laboratories agreed ...
(Date:4/28/2016)... Research and Markets has announced ... Market 2016-2020" report to their offering. ... The global plastic surgery products market is expected to ... 2016-2020. , ,The growing adoption of laser in aesthetics ... the market. Lasers are used to treat a broad ...
Breaking Medicine Technology: