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JAMA. 2005;294:1861.

Bariatric Surgery Mortality, Trends, Hospitalizations
Factors associated with bariatric surgery are explored in several articles in this issue of JAMA. First, in a retrospective cohort study, Flum and colleagues (SEE ARTICLE) evaluated the risk of early mortality among Medicare beneficiaries having bariatric surgery in 1997-2002. They found that 30-day, 90-day, and 1-year mortality rates were 2.0%, 2.8%, and 4.6%, respectively, and were associated with male sex, advancing age, and lower surgeon volume. In a second article, Santry and colleagues (SEE ARTICLE) detail results of their analyses of national data from 1998 to 2003 on bariatric surgical procedures, patient characteristics, and in-hospital complications. They found the number of procedures increased from 13 365 in 1998 to 102 177 in 2003, more than 80% of the patients were women, and the rate of in-hospital complications was stable during the period of study. In a third article, Zingmond and colleagues (SEE ARTICLE) analyzed California hospitalization rates and indications before and after a Roux-en-Y gastric bypass (RYGB) procedure. They found that the hospitalization rate more than doubled in the year after compared with the year before RYGB. Hospitalizations prior to RYGB were commonly for complications of obesity, whereas hospitalizations after RYGB were for RYGB-related complications. In an editorial, Wolfe and Morton (SEE ARTICLE) discuss morbid obesity and the benefits and risks of surgical treatment. In a commentary, Courcoulas and Flum (SEE ARTICLE) discuss challenges in conducting bariatric surgical research.

BRCA Mutations in Women of Diverse Ethnicity
BRCA1 and BRCA2 mutations, found in many families with multiple cases of breast and ovarian cancer, have received little study in ethnically diverse women. Nanda and colleagues assessed the frequency of BRCA1 and BRCA2 mutations, and the utility of the BRCAPRO statistical model for predicting the likelihood of a mutation, in white, Ashkenazi Jewish, and African American women with 2 or more familial cases of breast cancer, ovarian cancer, or both. Among their findings were the presence of BRCA1 and BRCA2 mutations in 28% of the women of African descent, with different mutations seen in African Americans than in women of European ancestry. BRCAPRO identification of mutation carriers was comparable in the 3 groups studied.

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Atypical Antipsychotics, Dementia, and Risk of Death
Atypical antipsychotic medications are often prescribed to treat aggression and other neuropsychiatric symptoms in elderly patients with dementia. However, they have been associated with an increased risk of adverse cardiovascular events and mortality. Schneider and colleagues (SEE ARTICLE) conducted a meta-analysis of data from clinical trials that compared atypical antipsychotics with placebo in the treatment of dementia to assess the mortality risk. They found a small increased risk of death in patients randomly assigned to an atypical antipsychotic compared with patients assigned to placebo. In an editorial, Rabins and Lyketsos (SEE ARTICLE) review antipsychotic drug risks and urge postmarketing mortality assessment to ensure patient safety.

A Piece of My Mind
"Reliance on God and faithful acceptance of His decree is a central concept in the Islamic tradition. Rather than a call for complacency, it serves as a source of strength in seemingly hopeless conditions." From "Tie It and Trust."

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Medical News & Perspectives
Although scientists and others are enthusiastic about nanotechnology’s potential uses in medicine and other fields, more research is needed to assess the possible health risks associated with the technology.

(Photo credit: AAAS)

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CLINICIAN’S CORNER
Dyspnea and Heart Failure
The Rational Clinical Examination
Usefulness of history, symptoms and signs, and diagnostic studies to distinguish heart failure from other causes of dyspnea in patients receiving care in emergency departments.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Information about bariatric surgery.

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Author in the Room
"Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures," published in the October 19, 2005, issue of JAMA, will be discussed for Author in the Room on November 16, 2005. Register for the conference and learn more at http://www.ihi.org/authorintheroom.

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