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Recent Improvements in Bariatric Surgery Outcomes

Encinosa, William E. PhD*; Bernard, Didem M. PhD; Du, Dongyi MS; Steiner, Claudia A. MD, MPH*

doi: 10.1097/MLR.0b013e31819434c6
Original Article

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 nonelderly 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.

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

Funded by the Agency for Healthcare Research and Quality. The views herein do not necessarily reflect the views or policies of AHRQ, nor the U.S. Department of Health and Human Services.

Supported by the Agency for Healthcare Research and Quality.

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:

© 2009 Lippincott Williams & Wilkins, Inc.