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Healthcare Utilization and Outcomes After Bariatric Surgery

Encinosa, William E. PhD*; Bernard, Didem M. PhD†; Chen, Chi-Chang PhD, MS, Pharm‡; Steiner, Claudia A. MD, MPH*

Medical Care:
doi: 10.1097/01.mlr.0000220833.89050.ed
Original Article
Abstract

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.

Author Information

From the *Center for Delivery, Organization, and Markets, and the †Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland; and the ‡School of Pharmacy, University of Maryland, Baltimore.

This study was funded by the Agency for Healthcare Research and Quality.

The views here do not necessarily reflect the views or policies of AHRQ or the U.S. Department of Health and Human Services.

Reprints: William E. Encinosa, PhD, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, 540 Gaither Road, Room 5105, Rockville, MD 20850. E-mail: wencinos@ahrq.gov.

© 2006 Lippincott Williams & Wilkins, Inc.