A new study by the US Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) found the average rate of postsurgical and other complications in patients who underwent bariatric surgery declined 21% between 2002 and 2006. Additionally, payments to hospitals dropped by as much as 13% for bariatric surgery patients during that time period, in part because fewer complications meant fewer readmissions.
“People considering an elective procedure need unbiased, science-based evidence of its benefits and risks,” says AHRQ director Carolyn M. Clancy, MD. “All surgeries involve risks, but as newer technologies emerge and surgeons and hospitals gain experience, as this study shows, risks can decrease.”
Results of the study showed that the complication rate among patients initially hospitalized for bariatric surgery dropped from approximately 24% to roughly 15%. A 58% reduction in the post-surgical infection rate accounted for much of the drop in complications. Abdominal hernias, staple leakage, respiratory failure, and pneumonia fell by 29% to 50%. Rates for other complications, such as ulcers, dumping (involuntary vomiting or defecation), hemorrhage, wound reopening, deep-vein thrombosis and pulmonary embolism, heart attacks, and strokes, remained relatively unchanged.
Hospital payments for bariatric surgery patients, as a whole, fell from $29,563 to $27,905. For patients who experienced complications, this number dropped from $41,807 to $38,175. Hospital payments for those who had to be readmitted because of complications fell from $80,001 to $69,960.
To conduct the study, senior economist William E. Encinosa, PhD, and his team compared complication rates among more than 9,500 patients under age 65 who underwent obesity surgery at 652 hospitals between 2001 and 2002 and between 2005 and 2006. The proportion of patients over age 50 operated on by bariatric surgeons increased from 28% to 44% during the period, and the average number of underlying illnesses in patients operated on by bariatric surgeons, such as diabetes, high blood pressure, or sleep apnea, more than doubled. The complication rate fell despite this increase in the percentage of older and sicker patients having the operations.
Encinosa credits the improvements largely to a combination of three factors; increased use of laparoscopy, a technology that allows physicians to operate through small incisions; increased use of banding procedures without gastric bypass, such as vertical-banded gastroplasty and lap band; and increased surgeon experience arising from the growth in the number of bariatric surgeries performed by hospitals.
The study appears in the May 2009 issue of Medical Care.