Characteristics of bariatric surgery in an integrated VA Health Care System: follow-up and outcomes

Abstract

Background. Since the 1991 NIH consensus conference, obesity surgery has been increasingly accepted as a form of therapy for morbid obesity. Approximately 40% of Veteran patients are obese and would potentially benefit from the operations.

Methods. Records were reviewed for all obesity operations performed at the Veterans Administration Greater Los Angeles Health Care System between January 1997 and April 2002. Morbidity, mortality, weight loss, and extent of follow-up were the outcomes measures assessed.

Results. Forty-six [11 Female (24%), 35 Male (76%)] patients underwent Roux-Y gastric bypass during the 63-month period we reviewed. There was one death from pulmonary hypertension unexpectedly encountered in the operating room. There was a single major complication: an anastomotic leak successfully treated with intravenous antibiotics. The Computerized Patient Record System contained extensive weight loss information, with dozens of weight measurements for these patients before and after surgery. Weight loss was sustained in all but 2 patients during the follow-up period. The only patients lost to follow-up were those referred from medical centers outside the boundaries of our integrated health care system.

Conclusion. (1) The VA population has the opposite male/female ratio of populations reported in most weight loss studies. Because the health risks attributable to obesity are greater in males, the VA represents an important population to study that may benefit significantly from weight loss surgery. (2) Extensive clinical information available in the computerized medical record combined with frequent accession of health care resources by our patients resulted in a database rich in follow-up data for a population where long-term outcomes are traditionally difficult to obtain. (3) There was very low surgical morbidity and mortality in a high-risk population. This contrasts with the results of most volume-outcome studies and occurred in a low-volume hospital by a high-volume surgical and medical team. (4) Distinct patterns of weight loss were observed.

Introduction

Since the 1991 NIH consensus conference regarding weight loss surgery was published, operations to control obesity have become an accepted form of therapy for the treatment of morbid obesity [1]. Although the morbidity and mortality attributable to obesity is high in women [2], it is substantially greater in men [3]. Despite this, few series examining the outcomes from obesity surgery have an appreciable number of male patients. The U.S. population is evenly divided numerically between males and females, yet more than 70% of seriously obese individuals are women. Consequently, most published series of bariatric surgery outcomes contain 70–80% women.

In the VA health care system male patients predominate. The incidence of obesity ranges from 40 to 50%. Because of the greater health risk associated with obesity in men, weight loss therapy is an essential aspect of medical care for the VA. Most morbidly obese patients fail to achieve long-term weight control with conventional diets. Weight loss surgery is ideally suited for this population because it can result in sustained weight loss and potentially reduce the health risk associated with obesity. The purpose of this study was to review our experience with Roux-Y gastric bypass (RYGB) in the Veteran population. We also examined the ability to acquire outcomes data not generally available for the lower socioeconomic patients cared for by the VA. In most studies, follow-up is limited for these categories of patients. The VA has organized into integrated health care systems with extensive electronic medical records that facilitate patient tracking. We studied the ability to obtain outcomes data in a population of RYGB patients enrolled in an integrated health care system with a highly developed electronic medical record system.