Houston UT MIST bariatric surgeon Erik B. Wilson MD discusses the potential risks and hidden costs of traveling across the U.S. border or overseas to undergo weight-loss surgery.
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Most people have heard of “medical tourism” from either the newspaper, television, Internet, or an acquaintance who has actually traveled outside the United States to gain access to surgical procedures, including bariatric surgery. Although promotions for medical tourism extol the benefits of having surgery for much less than the cost of the same procedure in the U.S., they fail to acknowledge the potential hidden costs and dangers—often fatal ones—inherent in traveling outside the U.S. for bariatric surgery.
According to Erik B. Wilson M.D., Medical Director of Bariatric Surgery at Houston’s UT MIST Center for Bariatric and Metabolic Surgery, a significant problem surrounding medical tourism for bariatric surgery is a fundamental misconception: bariatric surgery is not a single event from which patients emerge and begin to lose weight. Instead, it is part of a process that begins prior to surgery and lasts long after the last suture dissolves. Successful outcomes require conscientious preparation and regular follow-up visits with the surgeon, which enable the doctor to provide exceptional continuity of care, observe and treat any complications that may arise, and adjust medications, as needed, to meet each patient’s unique medical needs. Unless bariatric surgery patients plan to remain for many weeks or months in the country where they have their original procedure, this kind of individualized follow-up care with the primary surgeon is impossible to achieve.
Furthermore, patients who undergo bariatric surgery across the border have no guarantee that they will receive the same superlative quality of care that they can expect in the United States. Quality-control methods vary widely outside the U.S., and some countries have lenient mechanisms in place to ensure patient safety, consistency of care, and successful outcomes following bariatric surgery. In July 2015, for instance, ABC Action News reported that the fourth bariatric surgery patient of a surgeon from Tijuana, Mexico, died following surgery performed at his facility. Other bariatric surgery patients of his have suffered from serious complications due to surgical error, and one remains in a coma after traveling to what one eye witness claimed was an “unsanitary” surgical suite.
In contrast, U.S. hospitals and surgical suites must be certified and maintain certification by the Joint Commission, an independent, non-profit organization that ensures performance and quality standards. Also, bariatric surgeons must obtain certification and licensure before they are allowed to practice in the U.S. After they complete formal medical training to obtain their M.D. or D.O. degree, they must then complete a hospital residency training program in surgery. Every bariatric surgeon at the UT MIST Center for Bariatric and Metabolic Surgery is board certified, and many have additional training and certifications. Finally, the U.S. Food and Drug Administration assumes responsibility for protecting the public by assuring the safety, efficacy, and security of pharmaceutical agents and medical devices, which must undergo rigorous testing through clinical trials before receiving approval for use in patients. Other countries often have more lenient requirements regarding the use of new drugs or medical devices, putting patients at increased risk for unanticipated complications following bariatric surgery.
Finally, major surgery can lead to complications that require reoperation, even in the hands of the most skilled surgeons. One June 2015 study published in the journal Lancet suggests that, when reoperation is necessary, outcomes and survival rates improve dramatically when patients return to the same hospital where the original surgery was performed—ideally with the same surgical team. According to Benjamin S. Brooke MD, the study’s primary author, “Readmission to the index [original] hospital was associated with a 26% lower risk of 90 day mortality than was readmission to a non-index hospital.” These findings suggest important implications for bariatric surgery patients considering travelling across the border or overseas, as it would be logistically and financially impractical or impossible to return to the original hospital, and in certain cases, patients might not be healthy enough to do so.
This is not to say that competent, highly skilled bariatric surgeons do not exist outside the United States or that medical tourism is inherently bad. However, the staff and surgeons of UT MIST firmly believe that for a major operation and life event such as bariatric surgery, patients should remain in the U.S. Medical tourism should be considered only for procedures that incur minimal risk and require little follow-up care. For more information about bariatric surgery at the Houston UT MIST Center for Bariatric and Metabolic SurgeryFind Article, visit our website.
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