Lower Complications, Costs May Lead to More Bariatric Surgeries

Cheryl Clark, for HealthLeaders Media , May 1, 2009

A new federal study pointing to a dramatic decline in post-surgical bariatric complications–as well as the cost of the procedures–may pave the way for healthcare providers to attempt the procedure in even larger groups of sicker, older patients.

That may be one extrapolation from a survey just released by the Agency for Healthcare Research and Quality, which found that certain complications–particularly infections, which dropped 58%–fell from approximately 24% to 15% between 2001-2002  and 2005-2006.  The drop was attributed to increased use of laparoscopy and banding procedures without gastric bypass, as well as increased surgeon experience. Laparoscopy decreased the odds of a complication by 30% and drove down hospital payments by 12%.

The complication rate fell despite the fact that surgeons now perform the procedure more often in older and sicker patients.  The percentage of patients over age 50 who had the procedure increased from 28% to 44% in this timeframe, and the percentage of underlying illness, such as diabetes, high blood pressure, or sleep apnea, more than doubled.

The study also found that abdominal hernias, staple leakage, respiratory failure, and pneumonia complications all fell by between 29% and 50%.

“All surgeries involve risks, but as newer technologies emerge and surgeons and hospitals gain experience, as this study shows, risks can decrease,” said Carolyn M. Clancy, MD., AHRQ director.

Hospital payments for these procedures fell from $29,563 to $27,905 for patients who did not have complications. For patients who did, the price tag fell from $41,807 to $38,175.  Payment for patients who had to be readmitted because of their complications fell from $80,001 to $69,960.

It remains unclear why other complications, such as ulcers, involuntary vomiting or defecation, hemorrhage, wound re-opening, deep-vein thrombosis and pulmonary embolism, heart attacks, and strokes remained relatively unchanged.

The survey, led by AHRQ senior economist William E. Encinosa, compared 9,500 patients under age 65 who had the procedure done at 652 hospitals between 2001 and 2002, and between 2005 and 2006.

According to the Society for Metabolic and Bariatric Surgery the number of such procedures has risen exponentially, from 145,000 in 2004 to 220,000 in 2008. And more are expected this year.

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