Recent improvements in bariatric surgery outcomes

Med Care. 2009 May;47(5):531-5. doi: 10.1097/MLR.0b013e31819434c6.


Objective: Bariatric surgery is one of the fastest growing hospital procedures, but with a 40% complication rate in 2001. Between 2001 and 2005 bariatric surgeries grew by 113%. Our objective is to examine how 6-month complications improved between 2001 and 2006, using a nationwide, population-based sample. DATA/DESIGN: We examined insurance claims in 2001-2002 and 2005-2006 for 9582 bariatric surgeries, at 652 hospitals, among a population of 16 million non-elderly people. Outcomes and costs were risk-adjusted using multivariate regression methods with hospital fixed effects.

Principal findings: Between 2001 and 2006, while older and sicker patients underwent the surgery, the 180-day risk-adjusted complication rate declined 21% from 41.7% to 32.8%. Most of the improvement was in the initial hospital stay, where the risk-adjusted inpatient complication rate declined 37%, from 23.6% to 14.8%. Risk-adjusted rates of readmissions with complications declined 31%, from 9.8% to 6.8%. Risk-adjusted hospital days declined from 6 to 3.7 days, and risk-adjusted and inflation-adjusted payments declined 6%.Improvements in complication rates and readmission rates were associated with a within-hospital 30% increase in hospital volume. Volume had no impact on costs. The use of laparoscopy, which increased from 9% to 71%, reduced costs by 12%, while gastric banding decreased costs by 20%. Laparoscopy had no impact on readmissions, but the increase in banding without bypass reduced readmissions.

Conclusions: Improvements in bariatric outcomes and costs were due to a mix of within-hospital volume increases, a move to a laparoscopic technique, and an increase in banding without bypass.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Bariatric Surgery* / economics
  • Bariatric Surgery* / methods
  • Female
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Laparoscopy / statistics & numerical data
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Obesity / surgery
  • Patient Readmission
  • Postoperative Complications / epidemiology*
  • Quality of Health Care*
  • Risk Adjustment
  • Treatment Outcome
  • United States / epidemiology
  • Young Adult