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

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*

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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.

© 2006 Lippincott Williams & Wilkins, Inc.

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