Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada

Abstract

IMPORTANCEResults of previous studies are mixed regarding the economic implications of a Roux-en-Y gastric bypass (RYGB).OBJECTIVE To assess the 5-year incremental health care use and expenditures after RYGB. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study conducted in Ontario, Canada, used a difference-in-differences approach to compare health care use and expenditures between patients who underwent a publicly funded RYGB from March 1, 2010, to March 31, 2013, and propensity score-matched control individuals who did not undergo a surgical bariatric procedure. The study period allowed for a minimum 60 months of follow-up because, at that time, the most recent date for which administrative data on health care and expenditures were available was March 31, 2018. Data sources included the Ontario Bariatric Registry linked to several Ontario health administrative databases and the Electronic Medical Record Administrative Data Linked Database. Health care use and expenditures data for 5 years before and 5 years after the index date (procedure date for RYGB group; random date for controls) were analyzed. Data analyses were performed March 12, 2019, to March 10, 2020.INTERVENTION RYGB procedure. MAIN OUTCOMES AND MEASURESThe primary outcome was total health care expenditures. RESULTS The final propensity score-matched cohorts comprised 1587 individuals in the RYGB group (mean [SD] age, 47 [10.2] years) and 1587 controls (mean [SD] age, 47 [12.2] years); each group had 1228 women (77.4%) and a mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 46. Mean total health care expenditures (2017 Canadian dollars

Comparison of 4-Year Health Care Expenditures Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

“…We undertook a population-based, matched cohort study of residents of Ontario, Canada, who underwent publicly funded bariatric surgery with RYGB or sleeve gastrectomy from March 1, 2010, to March 31, 2015, and who consented to participate in the Ontario Bariatric Registry. Briefly, the Ontario Bariatric Registry 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 has collected real-world data since 2010 on all consenting patients eligible for publicly funded bariatric surgery in Ontario, Canada’s most populous province. In Ontario, individuals with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of at least 40 or a BMI of at least 35 with obesity-related comorbid conditions (eg, type 2 diabetes) are eligible for publicly funded RYGB, which is the primary bariatric surgery offered to patients with BMI of less than 60.…”

“…Sleeve gastrectomy is also publicly reimbursed when RYGB is not possible owing to small-bowel disease and/or adhesions or previous surgery or when sleeve gastrectomy is performed as a planned staged surgery in patients with a BMI of greater than 60 to enable the patient to lose weight. 16 As described elsewhere, 14 , 15 patient-level records of the Ontario Bariatric Registry were linked with administrative health care records housed at ICES. These data sets were linked using unique encoded identifiers and analyzed at ICES, Toronto, Ontario.…”

“…Data were analyzed from from May 5, 2020, to May 20, 2021. As in previous work comparing health care expenditures associated with RYGB vs no surgery in Canada, 15 we matched on a propensity score to create comparable cohorts of patients receiving RYGB vs sleeve gastrectomy. Variables included in the score were age, sex, BMI, year of surgery, geographical location (ie, 14 local health integration networks), census neighborhood income quintile, Ontario Marginalization Index, 18 number of major Aggregated Diagnostic Groups (ADG; derived from the Johns Hopkins ACG System, version 10.0), potentially confounding chronic medical conditions derived from validated administrative data case definitions (eg, chronic kidney disease, coronary artery disease, type 2 diabetes, hypertension, hypercholesterolemia, and mood and anxiety disorders), total health care expenditures in the 5 years preceding the index surgery date, and number of days in the hospital and number of emergency department visits in the 365 days preceding the index date.…”

Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study

“…Despite the undeniable health benefits, there are several studies reporting an increased use of health resources and costs after BS [ 25 , 38 , 39 ]. Indeed, several studies were assessed in a short period of time [ 25 , 27 , 28 , 38 , 39 ], while in the medium to long-term, a trend in the reduction of health resource and hospital use was uniformly reported, with figures that were at least similar, or even lower [ 14 , 24 , 25 , 39 , 40 , 41 , 42 ]. Accordingly, we found a significant reduction in the hospitalization rate in the long-term after BS.…”

“…On the other hand, a higher incidence of complications after RYGB have been reported, such as fall-related accidents, kidney stones and diseases, gastrointestinal disorders, micronutrient deficiencies, endocrine derangements [ 26 , 51 , 52 ] with respect to SG, which is considered to be a less technically demanding procedure. Furthermore, an increase in costs and hospitalization rates [ 26 , 29 , 30 , 38 , 39 , 41 , 53 ] were described after RYGB, with increased percentages of readmission, re-operation, and subsequent invasive procedures (frequently, complications due to the procedures, such as ventral hernia repair, small bowel obstruction, and gastric revision). A recent meta-analysis of randomized controlled trials, however, failed in drawing any conclusions regarding the long-term comparative effectiveness between RYGB and SG beyond 3 years [ 54 ].…”