News and Commentary

Costs and Complications Fall With Rising Use of Bariatric Surgery

Good news for insurers and patients considering undergoing bariatric surgery: The Agency for Healthcare Research and Quality (AHRQ) found that the rate of post-surgical and other complications in patients who undergo the procedures declined 21 percent between 2002 and 2006. AHRQ, in the study “Recent Improvements in Bariatric Surgery Outcomes,” also found that payments to hospitals dropped by as much as 13 percent for bariatric surgery patients during that period. The agency explained this drop in part because fewer complications meant fewer readmissions.

The complication rate in patients initially hospitalized for this surgery declined to roughly 15 percent, attributable to a lowered post-surgical infection rate. Incidents of abdominal hernias, staple leakage, respiratory failure, and pneumonia fell between 50 percent and 29 percent.

Most of the improvement was in the initial hospital stay, where the risk-adjusted inpatient complication rate declined 37 percent, from 23.6 percent to 14.8 percent.

Hospital payments for these patients fell from $29,563 to $27,905. Even payments for patients who experienced complications dropped, from $41,807 to $38,175. Hospital payments for the most expensive patients — those who had to be readmitted because of complications — fell from $80,000 to $69,960.

The agency attributes this decline to greater experience of surgeons and hospitals.

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

AHRQ researchers looked at complication rates for more than 9,500 patients under age 65 who underwent obesity surgery at 652 hospitals between 2001 and 2002 and between 2005 and 2006. The researchers found that “the complication rate fell in spite of an increase in the percentage of older and sicker patients having the operation.”

Hospital readmissions because of complications fell 31 percent, while complication-caused same-day hospital outpatient clinic visits declined from about 15 percent to 13 percent.

William E. Encinosa, PhD, the AHRQ’s senior economist and lead author, says that the improvements are attributable to three factors — increased use of laparoscopy, increased use of banding procedures without gastric bypass, such as lap band, and increased surgeon experience arising from the increase in the number of bariatric surgeries performed by hospitals.

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