1634 JAMA, JAMA is its name

Ask me again, and I'll tell you the same.

Cover: Andrew L. von Wittkamp, Black Cat on a Chair

I just go crazy when USAToday and Wall Street Journal spell out Journal of the American Medical Association. It changed its name in 1959 to JAMA.

Anyway, the infamous "today's issue" (there's a phrase that drives librarians crazy) apparently revealed some unsavory information about gastric by-pass surgery for the morbidly obese--patients are dying at a much higher rate than first thought. However, because they are using Medicare figures, and these people were severely disabled by their weight to even qualify for Medicare, they don't have records for people using private insurance for this study. Nor do they have records to show that medical problems requiring non-hospitalization have decreased. Often this surgery needs to be followed by surgery to remove huge skin folds. There's a lot that can go wrong.

Still, does it make sense that one man's family sues Vioxx because he died of an irregular heart rate and that drug which helped millions live with the pain of arthritis is taken off the market; but many people die after by-pass surgery and 48% are readmitted to the hospital within 30 days and the procedure is still used and recommended for unhealthy, obese people who can't lose weight any other way. Somehow, these figures aren't making sense to me. Most public libraries carry JAMA, so go look at it and see what you think.

"Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures" David R. Flum, MD, MPH; Leon Salem, MD; Jo Ann Broeckel Elrod, PhD; E. Patchen Dellinger, MD; Allen Cheadle, PhD; Leighton Chan, MD, MPH. JAMA. 2005;294:1903-1908. Abstract:

"Results: A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged 75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index.

Conclusions: Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients."