HUMC earns top rating for obesity surgery
Tuesday, November 21, 2006
By MARY JO LAYTON
STAFF WRITER
At 368 pounds, Jody Stafford was guaranteed to die early, her doctor said. She was so overweight, her breathing was obstructed and she had to sleep with an oxygen mask.
The Waldwick woman had bariatric surgery in August to reduce her stomach to a pingpong-ball-size pouch – and she has lost 92 pounds.
She's no longer afraid of getting stuck in airline seats. Tiny meals aren't torture. "When you lose this much weight, everything changes," said Stafford, 46.
As more obese Americans turn to bariatric surgery to lose weight, a study of procedures across the nation has found large gaps in quality in hospitals in New Jersey and elsewhere.
In the study by Health Grades, a patient undergoing obesity surgery had a 66 percent lower chance of developing major complications at a hospital that received the best rating compared with hospitals that received the worst.
The complications included heart attack, pneumonia and excessive bleeding. The death rate was two out of every 1,000 surgeries.
Health Grades, a health-care company that rates hospital performance, studied 86,520 surgeries nationwide and gave hospitals from one to five stars, with five being the best.
Five-star rating
In North Jersey, Hackensack University Medical Center stood out -- the only hospital to receive the five-star rating. The program, one of the largest in the nation, treats nearly 1,000 patients a year and has become a regional training center for other surgeons, hospital officials said.
"Clearly the idea that the more you do the better you get at it is true,'' said Regina Berman, director of performance improvement at Hackensack.
Complication rates in North Jersey ranged from 3.85 at Hackensack to 16.28 percent at St. Clare's Hospital in Denville.
With hospitals heavily marketing their programs -- the billboards on Routes 4 and 17 are inescapable -- and demand growing dramatically, the number of procedures has quadrupled since 2000, reaching 171,000 in 2005, according to the American Society for Bariatric Surgery.
Most obesity surgeries are gastric bypass, in which a surgeon radically reduces the size of the stomach and separates the upper part from the lower, causing food to bypass a part of the small intestine, limiting calorie absorption.
Another popular surgery is gastric banding, where an adjustable band is implanted to restrict the size of the stomach.
Other programs in the area received a three-star rating: Englewood Hospital and Medical Center, The Valley Hospital in Ridgewood, Holy Name Hospital in Teaneck, Pascack Valley Hospital in Westwood, Barnert Hospital in Paterson and St. Clare's Hospital in Denville.
Some New Jersey hospitals, including The Valley Hospital, said their programs have improved dramatically since the survey was conducted, from 2002 to 2004. Now affiliated with top-ranked New York-Presbyterian in Manhattan, the program in Ridgewood offers the same surgeons and more closely reflects Columbia's five-star rating, said Giovanni Dugay, Valley's bariatric surgery clinical coordinator.
Even though the survey reports gaps in quality, patients should consider the procedure relatively safe, said Dr. Neil Hutcher, a surgeon and immediate past president of the American Society for Bariatric Surgery.
"In the worst hospitals, your chance of dying was three out of 1,000,'' he said. "That's the same as having your appendix out or your gall bladder removed,'' he said.
Bariatric surgery is expected to become even more common now that Medicare pays for the procedure for patients suffering from health problems related to their weight. The government now picks up the tab as long as the procedure is performed at a so-called center for excellence. New Jersey has four such centers, with St. Barnabas Medical Center in Livingston being the closest. (Its program received five stars from Health Grades.)
Even with many insurers not paying, patients still opt to spend up to $30,000 for a gastric bypass and about $20,000 for the banding.
As the demand grows, the surgery has come under closer scrutiny.
In October, two large studies concluded that the surgery is much riskier than thought, with patients facing a far greater chance of being hospitalized and dying following the procedures.
In many cases, complications emerge weeks or months later, including vomiting, diarrhea and serious nutritional deficiencies.
Medical malpractice attorney Dennis Donnelly represents a woman who sued her physician in Morris County, claiming vitamin deficiencies after the surgery caused serious health problems.
The 31-year-old woman has double vision and other eye problems that make her virtually blind, he said. She suffers from migraines, vomiting, dizziness and an inability to walk at times. She can no longer work, he said.
"As this surgery becomes more popular, we're expecting to see more of these cases,'' Donnelly said.
Jody Stafford suffered complications after her gastric bypass surgery in August. She later had to have surgery to correct a stricture, or narrowing, of her digestive tract.
Because patients are typically in ill health caused by excessive weight, patients must be carefully screened, said Dr. Joseph Kamelgard, a bariatric surgeon at Pascack Valley Hospital. He turns away smokers and diabetics who don't have their disease under control.
Still, potential candidates must weigh the dangers of doing nothing, he said.
"For people with a BMI [body mass index] of 40 or greater, there's a significant loss of years of life,'' he said. "If we can treat the obesity these other conditions go away, the high blood pressure, high cholesterol, diabetes, sleep apnea.''
Obesity Surgery Complication Rates
Fast facts
The Health Grades survey of 86,530 obesity surgeries in 17 states rated seven programs in North Jersey hospitals. Typically, hospitals with higher patient volumes reported fewer in-hospital complications:
HospitalSurgeries ComplicationsHackensack University Medical Center 1,3503.85%Valley Hospital, Ridgewood1809.44%Englewood Hospital and Medical Center16110.56%Holy Name Hospital, Teaneck20011.50%Pascack Valley Hospital, Westwood6513.85%St. Clare's Hospital, Denville4316.28%Barnert Hospital, Paterson21016.67%
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