Bariatric Surgery Trends in California Hospitals

The increasing popularity of weight loss surgery prompted the State of California to examine hospitalization data for bariatric procedures, focusing on patient characteristics, cost, outcomes, and the hospitals where the surgeries were performed.

Among the key findings of the report is the fairly recent and rapid shift away from open Roux-en-Y gastric bypass, the rapid increase in Lap-Band procedures, the low mortality rates as well as the more common complication and hospital readmission rates associated with bariatric surgery.

The report, “Trends in Bariatric Surgery in California Hospitals, 2005-2009,” is one in a series of reports from the Office of Statewide Health Planning and Development (OSHPD) examining the quality and safety of healthcare in California.

For the study, researchers analyzed the 2005-2009 California Patient Discharge Data. All morbidly obese individuals who underwent at lease one bariatric surgery during the study period at a California hospital were included in the study.

The report focused on five main types of bariatric surgery: Open Roux-en-Y Gastric Bypass Surgery (Open RYGB), Laparoscopic Roux-en-Y Gastric Bypass Surgery (Lap RYGB), Laparoscopic Adjustable Gastric Banding (Lap Band), Vertical Sleeve Gastrectomy (VSG), and Biliopancreatic Diversion (BPD).

According to the OSHPD Health Facts report, there were 14,572 bariatric surgeries performed in California hospitals in 2009. The researchers noted the following key findings in the report:

• LapBand surgeries increased from 737 in 2005 to 3260 in 2009
• VSG procedures increased from 61 in 2005 to 864 in 2009
• Open RYGB procedures decreased from 2289 in 2005 to 367 in 2009
• Lap RYGB was the most common type of procedure, accounting for 73% of all bariatric surgeries performed in hospitals
• Deaths within 30 days following bariatric surgery are quite rare (1.5 per 1000 surgeries or about 20 per year)
• Hospital readmission rate within 30 days following bariatric surgery was 6.5%. Approximately 13% of patients experienced complications following bariatric surgery. The procedures associated with the highest complication rates, death rates, and length of hospital stay were Open RYGB and BPD
• Lap Band procedures were associated with the lowest complication rates, readmission rates, death rates, and length of hospital stay
• The majority of patients were female (80%); the average patient age was 44 years (ranged from 7 years to 82 years); by race/ethnicity most patients were White/Non-Hispanic (68.4% ), Hispanic (18.2%), and Black (8.6% )
• The most common comorbid conditions were nutritional, endocrine, and metabolic disorders (71.4%); hypertension (52%); non-traumatic joint disorders (43.7%); upper gastrointestinal disorders (41.3%); disorders of lipid metabolism (33.6%); and diabetes (30.9%)
• The median hospital charge for all bariatric procedures ranged from $50,305 to $54,535. Expected payer source for bariatric surgery was private insurance (80%), Medicare (7.2%), Medi-Cal (5.5%) and self-pay (4.3%)

In the report, it was noted that one of the limitations of the study is that it only looks at bariatric procedures performed in hospitals and does not address surgeries performed in outpatient facilities. The authors say other data sources show that nearly all bariatric procedures performed in outpatient settings are Lap Band surgeries, and that at least twice as many Lap Band procedures are performed outside hospitals as inside them.

The authors concluded that while the report may not be precise, it still provides the best estimates currently available on bariatric surgery.

This is the first time a report provides details about bariatric surgeries performed at California-licensed hospitals. The information should prove useful for individuals looking into their bariatric surgery options and deciding where to go for bariatric surgical care.

California is the only state besides New Jersey that publicly tracks the procedure by hospital.

Source: OSHPD Health Facts, Trends in Bariatric Surgery in California Hospitals, 2005 to 2009 by David Alexander | wlshelp.com