Chronic Disease

The complications and costs of obesity surgery are declining

Complications from bariatric (obesity) surgery dropped 21 percent from 2002 to 2006. The finding comes from a new study by William E. Encinosa, Ph.D., Didem M. Bernard, Ph.D., and Claudia A. Steiner, M.D., M.P.H., at the Agency for Healthcare Research and Quality (AHRQ), and Dongyi Du, Ph.D., at the University of Maryland, Baltimore. As a result of fewer complications and subsequent hospital readmissions, payments to hospitals slid by as much as 13 percent. The study compared complication rates in more than 9,500 patients who underwent bariatric surgery at 652 hospitals between 2001 and 2002 and between 2005 and 2006. During the earlier period, the 180-day risk-adjusted complication rate was 42 percent. This dropped to roughly 33 percent during the most recent period. Postsurgical infection rates also declined 58 percent.

Complications ranging from hernias to respiratory failure and pneumonia also fell substantially. However, the rate for dumping (including vomiting or diarrhea) did not change significantly (19 percent vs. an earlier 21 percent). For patients with no complications, hospital payments for the surgery decreased from $29,563 to $27,905. When complications did occur, payments still dropped from $41,807 to $38,175. Also, hospital payments for readmitted patients fell from $80,001 to $69,960. Such drops in complication rates are especially encouraging, since older and sicker patients are now having bariatric surgery. For example, the proportion of patients over age 50 increased from 28 percent to 44 percent, and the number of underlying illnesses in bariatric patients more than doubled during the period.

The 6-month postsurgical death rate between 2005 and 2006 was 0.05 percent, virtually unchanged since 2001 and 2002. Overall, the researchers attribute the reduced complication rate and lower costs to the increased use of minimally invasive techniques (laparoscopy), an increase in surgeon volume, and the growing popularity of banding procedures over traditional bypass surgery.

More details are in "Recent improvements in bariatric surgery outcomes," by Drs. Encinosa, Bernard, Du, and Steiner, in the May 2009 Medical Care 47(5), pp. 1-5.

Reprints (AHRQ Publication No. 09-R050) are available from the AHRQ Publications Clearinghouse.

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