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Costs for bariatric surgery declining

A new study by the Department of Health and Human Services' Agency for Healthcare Research and Quality indicates the average rate of post-surgical and other complications in patients who have bariatric surgery, declined 21 percent between 2002 and 2006.

The study found that payments to hospitals dropped by as much as 13 percent for bariatric surgery patients during that time period, in part because fewer complications meant fewer readmissions.

The study, "Recent Improvements in Bariatric Surgery Outcomes," to be published in the May 2009 issue of Medical Care, found that the complication rate among patients initially hospitalized for bariatric surgery dropped from approximately 24 percent to roughly 15 percent.

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Much of the decline was driven by a reduction in the post-surgical infection rate, which plummeted 58 percent. Abdominal hernias, staple leakage, respiratory failure and pneumonia fell by between 29 percent and 50 percent.

In addition, hospital payments for bariatric surgery patients, as a whole, fell from $29,563 to $27,905, and 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 $80,001 to $69,960.

"People considering an elective procedure need unbiased, science-based evidence of its benefits and risks," said AHRQ Director Carolyn M. Clancy, MD. "All surgeries involve risks, but as newer technologies emerge and surgeons and hospitals gain experience, as this study shows, risks can decrease."

AHRQ researchers, led by senior economist William E. Encinosa, compared complication rates among more than 9,500 patients under age 65 who underwent obesity surgery at 652 hospitals between 2001 and 2002 and between 2005 and 2006.

They found that the complication rate fell in spite of an increase in the percentage of older and sicker patients having the operations. The proportion of patients over age 50 operated on by bariatric surgeons increased from 28 percent to 44 percent during the period, and the average number of underlying illnesses in patients operated on by bariatric surgeons, such as diabetes, high blood pressure or sleep apnea, more than doubled.

The six-month post-surgical death rate for patients operated on between 2005 and 2006 was 0.5 percent, statistically about the same as that of patients who had bariatric surgery between 2001 and 2002. Hospital readmissions because of complications fell 31 percent, to roughly 7 percent, while complication-caused same-day hospital outpatient clinic visits declined from approximately 15 percent to 13 percent.