The report includes recommendations that hospitals and surgeons perform a high number of surgeries in order to stay in practice, which ultimately could force some smaller programs at community hospitals to close. Based on their review of medical studies, panel members said hospitals that do more than 100 surgeries a year, and surgeons who do 50 to 100 cases a year, have lower complication rates.
"This is going to send a clear message about what you need to have in your surgery program, and if you don't, you should rethink it," said Christine Ferguson, commissioner of the Massachusetts Department of Public Health, who herself had weight-loss surgery a year ago.
Ferguson, who up until now hadn't spoken publicly about her surgery, said that because of her experience, she made sure the panel developed information that patients could use in choosing a surgeon. Ferguson, 45, has lost 100 pounds -- halfway toward her goal -- since having "lap band" surgery, in which doctors tie a silicon band around the stomach to shrink its size.
"People should look at all the options, but they also need to know there's hope," she said. "They shouldn't withdraw from society."
The January death of Howard Reid, a 37-year-old computer technician and Harvard University security guard, shortly after obesity surgery triggered the expert panel. Six other deaths or serious complications related to obesity surgery in Massachusetts have been reported to public health officials since 1998.
But Ferguson said yesterday that all surgery is risky: Obesity surgery carries up to a 1 percent chance of death. The other impetus for forming the panel, she said, is the growing popularity of the surgery. Massachusetts doctors did 2,761 gastric bypass operations and other types of obesity surgeries last year, compared to the 402 cases they did in 1998.
The 17-member panel, including many surgeons and nurses, reviewed the quality of hospital bariatric surgery programs. Their detailed report includes guidelines for nearly every aspect of obesity surgery including exactly which patients should be allowed to undergo the procedure, to how to tailor anesthesia for obese patients, for whom surgery is especially risky.
One guideline recommends surgery only at hospitals that perform 100 or more cases annually. Only 14 of the state's 24 hospitals that do obesity surgery perform that many, said Dr. George Blackburn, vice chairman of the panel and a physician at Beth Israel Deaconess Medical Center. The panel also recommended that hospitals adopt strict standards for doctors before allowing them to perform obesity surgery.
For traditional weight-loss surgery, during which doctors make a long incision, hospitals should have an experienced surgeon monitor a new surgeon for 10 cases. The hospital should then review the next 15 cases of the new surgeon, to make sure standards are met, before granting full privileges to the surgeon.
Ferguson said the Department of Public Health would review the recommendations and consider whether to adopt actual regulations. But she said she is reluctant to do so, because medical practice changes so quickly. Instead, she expects education and peer pressure will force all hospitals and doctors to adopt the standards.
Patients also will vote with their feet, opting for surgery at hospitals that meet the "best practice" standards, she said, while insurers may pay for the surgery only at hospitals that follow the recommendations. The Public Health Department will post the recommendations on its website.
"I can't imagine anyone who's doing this surgery who wouldn't integrate these guidelines into their practice," said Nancy Ridley, an assistant commissioner of public health and head of the Betsy Lehman Center for Patient Safety and Medical Error Reduction. "I expect every hospital will do this."
Liz Kowalczyk can be reached at [email protected].