Monday, November 10, 2003

The GruntDoc had a post about a postoperative death after a gastric bypass. The hospital was blaming a stapler "malfunction" for the problem. Well from this story that Ross has found, this has happened before:

Another of Lautz's patients complained to the board late last year about his handling of her obesity surgery. She developed complications after surgery and complained she could not reach Lautz despite repeated phone calls, according to board documents. The board sent him a letter saying "communication is a key to any successful patient-physician relationship." In that case, Lautz said a staple gun misfired on him, and the patient also developed a stomach leak.

Gastric bypass carries a high risk overall:

But patients face serious risks, sometimes death. In gastric bypass programs at most academic medical centers, like Brigham, about one in every 200 or 300 patients die of complications from surgery, said physicians at one-half dozen hospitals. Three patients, including Simonelli, out of 750 operations have died since the mid-1990s, at Brigham, Zinner said.

In comparison, Zinner said, fewer than one of 1,000 patients die from gall bladder surgery, while two or three patients of 100 die from coronary bypass surgery, one of the riskier procedures.

So based on the above statistics, the program at Brigham is about average. A gastric leak is a recognized complication of a bypass operation. And apparently, according to the story, a problem was recognized at the time of surgery:

During Simonelli's surgery, Lautz noticed that staples in one row had popped out, so he converted the operation to a traditional open surgery, Whittemore said. Lautz closed that portion of her stomach with traditional hand sutures, Whittemore said.....During an autopsy, doctors discovered another part of a staple row had come undone and that some of her stomach contents had leaked out, Whittemore said.

Doesn't say if it was the same staple row, or one of the others. This answers the question I posed in my comment on Grunt Doc's post. Not knowing all the details it seems to me that conversion was the right thing to do, given the circumstances presented in the article. Then this:

Her surgeon, Dr. David Lautz, has performed hundreds of gastric bypass surgeries, so Zinner does not believe lack of training was to blame

I don't think so either, but doing "hundreds" of any procedure does not immunize one from complications. Every surgeon has complications from time to time and you need to know how to recognize them and correct them. As I often say when I hear about a colleague's problem, "There but for the grace of God go I." I haven't done a gastric bypass in years and have no desire to start doing them again.

Given the immediate circumstances surrounding this young lady's unfortunate death, I believe it was a pulmonary embolus that was a cause of her demise:

Afterward, Simonelli did well her first day. On the second day, she sat in a chair in her room and asked a nurse for help getting into bed. The nurse left the room to fetch wound dressing, Whittemore said, and when she returned, Simonelli had no pulse and was not breathing.

But that's just an educated guess. I think that the hospital is bringing unwelcome attention to itself by blaming the stapler for this problem, but I guess they feel the need to defend themselves in the court of public opinion.

UPDATE: Was doing some more thinking (a dangerous thing to do, I know) when I did the math. Given the 103,200 gastric bypass operations expected to be performed this year, and the 1/200-300 mortality rate, this means that, statistically, one patient having a gastric bypass dies every day.
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