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Recent Studies And Surveys
Health Affairs: Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates -- Using data from 1998 and 2006 Medical Expenditure Panel Surveys (MEPS) - "a nationally representative survey of the civilian noninstitutionalized population that quantifies a person"s total annual medical spending by type of service and of payment" - the authors estimate the health cost of obesity in the U.S. is $147 billion. "Across all payers, per capita medical spending for the obese is $1,429 higher per year, or roughly 42 percent higher, than for someone of normal weight. In aggregate, the annual medical burden of obesity has increased from 6.5 percent to 9.1 percent of annual medical spending and could be as high as $147 billion per year (in 2008 dollars) based on the NHEA [National Health Expenditure Accounts] estimate," according to the study. In conclusion, the authors write, "The take-home message is that without a strong and sustained reduction in obesity prevalence, obesity will continue to impose major costs on the health system for the foreseeable future. And although health reform may be necessary to address health inequities and rein in rising health spending, real savings are more likely to be achieved through reforms that reduce the prevalence of obesity and related risk factors, including poor diet and inactivity" (7/27).
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A Selection Of Thursday's Editorials And Opinions
The GOP Can Stop ObamaCare Wall Street Journal
News of the day
U.S. Appeals Court Rules To Enforce Illinois Parental Notification Law
A three-judge panel of the U.S. Court of Appeals for the 7th Circuit on Tuesday lifted, an injunction blocking the enforcement of an Illinois law that requires parental notification 48 hours before minors can undergo abortion procedures, the AP/South Town Star reports. The Illinois Legislature originally passed the law in 1984 and revised it in 1995. In 2007, U.S. District Judge David Coar issued an injunction blocking enforcement of the law. On Tuesday, the appeals court said that the measure was "a permissible attempt to help a young woman make an informed choice about whether to have an abortion."The American Civil Liberties Union, which challenged the law, argued that a provision that allows a notification of a judge, rather than a parent, would be unworkable in practice. In an opinion by Judge Richard Cudahy, the appeals court panel said, "We acknowledge that there might be practical problems with the procedure at issue here" and that "it may be intimidating for a minor to navigate the process of presenting her case to a judge, for instance." It continued, "But we fail to see a better alternative. Abortion, no matter how it is confronted, may present intimidating choices to the minor woman who faces it."The law will take effect within a few weeks unless opponents ask for a stay. Ed Yohnka, an ACLU spokesperson, said that it is unclear what the next step would be but that the appeals court could be asked to rehear the case (Robinson, AP/South Town Star, 7/15).
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Total Laparoscopic Aortic Surgery Is Feasible, Shows Satisfactory Results

Recently the use of laparoscopy for vascular procedures has been limited by difficulties in aortic exposure and anastomosis techniques, as well as the concurrent competitive progress of endovascular surgery. For aortic repair, best results (in terms of long-term patency) have been obtained by conventional surgery which has been associated short-term morbidity and mortality. Endovascular techniques (which are noninvasive but have less reliable long-term results) as well as video-endoscopic aortic surgery are alternatives to conventional surgery. Minimally invasive surgery benefits include reduced time in intensive care and a shorter hospital stay; a quicker resumption of intestinal transit; less abdominal wall complications; and reduced requirements for anelgesics. "The goal of total laparoscopic aortic repair is to achieve the same outcome as open repair without invasive laparotomy," said Jē©rē“me Cau, MD, professor at Poitiers University Hospital in Poitiers, France. "However, specialized training is required to master the procedure and get acquainted with coelioscopic practice necessary for laparoscopic suture." Dr. Cau said he and fellow researchers performed a study that completed a retrospective analysis of laparoscopic techniques for vascular procedures in a series of 219 patients, to determine its feasibility for treatment and outcomes with respect to aortic occlusive disease (AOD), abdominal aortic aneurysms (AAA) and aorto-renal bypass in the endovascular era. These findings were presented today at the 63rd Annual Meeting of the Society for Vascular Surgery®. One hundred and twenty-seven AODs; 80 AAAs and 12 aorto-renal bypasses were studied from the hospital; this series did not include 110 aortic bypass patients operated on in others centers by this team. The mean patient age was 61 years and the gender ratio was three men to one woman. The mean operative time of procedures for AOD was 223 (÷±50) minutes, with a mean clamp time of 56 (÷±21) minutes. A total of 3.6 percent of AOD procedures had to be converted to open surgeries. For laparoscopic AAA procedures, the mean operative time was 262 (÷±57) minutes and the mean "clamp time was 103 (÷±15) minutes. Eight AAAs had to be converted to an open procedure. The 30-day mortality rate was 0.9 percent. Overall mortality rate was 13.4 percent during a mean follow-up time of 16.2 months. The primary assisted patency rate for AAAs and occlusive disease was 100 percent. Dr. Cau added that as any in any relatively new technique, laparoscopy"s place in vascular surgery remains to be defined. He noted that for aortoiliac occlusive diseases, this technique has shown excellent results and should compete with open repair for the treatment of TASC C & D occlusive diseases. "Aneurysm repair in laparoscopy has been demonstrated to be feasible and reliable, and in our experience showed promising and satisfactory results," noted Dr. Cau. "In the aneurysmal pathology we can predict that the competition with endovascular aortic repair (which is becoming the standard) will make laparoscopy more difficult to "find its place" and make room for hybrid techniques. Specific training remains particularly important to reach technical success in laparoscopy and needs to be presented to the young generation of vascular surgeons in university pilot center." "Precise indications for this kind of surgery, compared to endovascular and open surgery, remain to be determined by randomized studies," added Dr. Cau. "Nevertheless, it is a difficult technique. Further development will rely on effective training, advances in technique and instrumentation." About the Society for Vascular Surgery® The Society for Vascular Surgery (SVS) is a not-for-profit society that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 2,800 vascular surgeons dedicated to the prevention and cure of vascular disease. Society for Vascular Surgery


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