Healthcare Utilization and Outcomes after Bariatric Surgery

• Published in: Medical care Vol. 44; no. 8; pp. 706 - 712
• Main Authors: Encinosa, William E., Bernard, Didem M., Chen, Chi-Chang, Steiner, Claudia A.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-08-2006; Lippincott Williams & Wilkins, Inc; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adolescent; Adult; Bariatric Surgery; Bariatrics; Clinical outcomes; Comorbidity; Data Collection; Diabetes complications; Female; Gastric bypass; Gastrointestinal surgery; Health care industry; Health outcomes; Health Services - utilization; Humans; Insurance Claim Reporting; Male; Middle Aged; Obesity; Obesity - surgery; Postoperative complications; Postoperative Complications - epidemiology; Regression Analysis; Surgical procedures; United States - epidemiology; Weight control; United States
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/01.mlr.0000220833.89050.ed

Objective: Bariatric surgery is one of the fastest growing hospital procedures. Our objective is to examine the safety outcomes and utilization of resources in the 6 months after bariatric surgery using a nationwide, population-based sample. Data/Design: We examine insurance claims for 2522 bariatric surgeries, at 308 hospitals, among a population of 5.6 million nonelderly people covered by large employers in the 2001-2002 MarketScan data. Outcomes and costs were risk-adjusted using multivariate regression methods. Principal Findings: Although the complication rate was 21.9% during the initial surgical stay, the rate increased by 81% (P < 0.01) to 39.6% (95% confidence interval, 37.7-41.5%) over the 180 days after discharge. A total of 10.8% of the patients without 30-day complications developed a complication between 30 days and 180 days. Overall, 18.2% of the patients had some type of postoperative visit to the hospital with a complication (through readmission, outpatient hospital visit, or emergency room visit) within 180 days. Although there was no difference between men and women, the near-elderly had a 26% (P < 0.01) higher risk-adjusted complication rate than those age 18 to 39 years. Total 6-month risk-adjusted healthcare payments were $65,031 for those with 180-day readmissions compared with $27,125 for those without readmissions (P < 0.01). Conclusion: In contrast to current bariatric studies, which report a 20% in-hospital complication rate, we find a significantly higher complication rate over the 6 months after surgery, resulting in costly readmissions and emergency room visits. Thus, a clear way to reduce the costs and improve outcomes of bariatric surgery is to address the high rate of postoperative complications.