Healthcare Utilization and Outcomes After Bariatric Surgery

Encinosa, William; Bernard, Didem; Chen, Chi Chang; Steiner, Claudia

doi:10.1097/01.mlr.0000220833.89050.ed

Cited by 162 publications

(114 citation statements)

References 14 publications

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“…The same occurred in the three-year follow-up cohort of Zingmond et al 21 and the studies by Encinosa et al 22 Our findings confirm that, at least over the short term, from the payer's point of view, the costs do not diminish after surgery; instead, they tend to increase. As expected, the costs in the subgroup with any type of complication after bariatric surgery or a gastrointestinal tract procedure were much higher than among those with uncomplicated procedures.…”

Section: Discussionsupporting

confidence: 79%

Costs and usage of healthcare services before and after open bariatric surgery

2011

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CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities.There are no studies comparing costs before and after bariatric surgery in Brazil.The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.reSUMO CONTEXTO E OBJETIVO: Indivíduos obesos mórbidos são grandes consumidores de serviços de saúde, com altos custos associados. A cirurgia bariátrica é uma alternativa para melhorar suas comorbidades. Não existem estudos comparando custos antes e após a cirurgia bariátrica no Brasil. O objetivo deste estudo foi analisar os resultados assistenciais e gastos diretos de pacientes obesos mórbidos submetidos à cirurgia bariátrica. TIPO DE ESTUDO E LOCAL: Coorte histórica de pacientes assistidos por um plano de saúde na cidade de Belo Horizonte, Minas Gerais. MÉTODOS: Foram incluídos na análise todos os serviços de saúde e seus custos associados: hospitalizações, permanência hospitalar, consultas eletivas e de emergência e exames. A análise foi tratada como total quando incluía todo o ano anterior e posterior à cirurgia, e parcial quando excluía os trimestres adjacentes à cirurgia. RESULTADOS: Para 382 pacientes obesos operados, houve 53 internações um ano antes e 95 um ano após a cirurgia (P = 0,013). As principais indicações para internação pós-procedimento foram complicações relacionadas ao trato gastrointestinal. O custo parcial médio quase dobrou no período pós-operatório (US$ 391,96 versus US$ 678,31). Em análise de s...

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Section: Discussionsupporting

confidence: 79%

Costs and usage of healthcare services before and after open bariatric surgery

2011

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“…Some recent studies have reported that Roux-en-Y (R-Y) gastric bypass, known as bariatric surgery, sometimes caused postoperative hyperoxaluria and subsequent oxalate nephrolithiasis in obese patients [1]. This metabolic abnormality sometimes leads to the development not only of macroscopic renal stones but also of microscopic renal calculi, and results in irreversible renal failure in some patients [2].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

et al. 2012

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Background Roux-en-Y (R-Y) gastric bypass, also known as bariatric surgery, sometimes causes postoperative hyperoxaluria and subsequent oxalate nephrolithiasis in obese patients. In this study, we retrospectively investigated the frequency of occurrence of nephrolithiasis and renal dysfunction in postoperative gastric cancer patients with respect to the surgical procedures employed. Methods Two hundred and twenty-six consecutive gastric cancer patients, who underwent distal gastrectomy with Billroth-I reconstruction (DGBI, 60 patients), distal gastrectomy with R-Y reconstruction (DGRY, 81 patients), and total gastrectomy with R-Y reconstruction (TGRY, 85 patients), were investigated for postoperative nephrolithiasis and renal dysfunction. We also examined the risk factors for postoperative nephrolithiasis in these patients with gastric cancer. Results Nephrolithiasis was detected in 3 (5 %), 7 (9 %), and 21 (25 %) patients in the DGBI, DGRY, and TGRY groups, respectively. There were significant differences in the frequency of nephrolithiasis between the DGBI and TGRY groups (p = 0.004), and between the DGRY and TGRY groups (p = 0.011), but there was no significant difference between the DGBI and DGRY groups. Multivariate logistic regression analysis revealed that gender and extent of gastrectomy were independent risk factors associated with nephrolithiasis. Renal dysfunction was found in 5 patients (6 %) in the TGRY group, but was not found in either the DGBI or the DGRY group. Nephrolithiasis was detected in all these 5 patients, and a renal biopsy performed in one patient revealed the presence of intratubular calcium oxalate crystals with chronic tubulointerstitial nephritis. Conclusion Total gastrectomy with R-Y reconstruction was an independent predictive factor for nephrolithiasis in patients with gastric cancer.

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“…Although complication rates with bariatric surgery when patients are in hospital are high (~20%), a study in the US reported significantly higher complication rates over the 6 months following surgery, resulting in costly readmissions and emergency room visits. 31 Furthermore, Encinosa et al 31 reported that the rate of readmission of bariatric patients increases 64.5% between 30 and 180 days after surgery. It is plausible that after cancellation of health insurance, private patients require access to public services for treatment and revision/reversal.…”

Section: Discussionmentioning

confidence: 99%

Quantitative analysis of bariatric procedure trends 2001–13 in South Australia: implications for equity in access and public healthcare expenditure

Meyer

Booth²,

Gray³

et al. 2015

Aust. Health Review

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Objectives. The aims of the present study were to: (1) identify trends in bariatric surgery in South Australia (SA) from 2001 to 2013; and (2) compare public and private hospitals, and so discuss the implications of these trends as they relate to equity in access to bariatric procedures and public system healthcare expenditure.Methods. An analysis of retrospective data of all bariatric procedures in public and private hospitals in SA was conducted using all SA public and private hospital administrative records between 2001 and 2013.Results. Of all procedures conducted in SA, 22.6% were revisions or reversals. The number of revisions or reversals conducted in SA has increased at a rate higher than weight loss procedures (6.4-vs 3.8-fold increase). An increasing proportion of public surgeries are revisions or reversals of weight loss procedures that occurred outside of the SA public system (interstate or in the private system).Conclusion. Further investigation is necessary to identify the pathways patients navigate to access bariatric surgery, the utilisation of public services following private procedures and why rates of revisions or reversals of bariatric procedures are increasing in SA.What is known about the topic? Rates of bariatric surgery are increasing internationally as a treatment for obesity. What does this paper add? Trends in bariatric procedures in SA have not been published. We have identified that: (1) rates of bariatric revisions or reversals in SA far surpass the rate at which bariatric weight loss procedures are increasing; (2) rates of revisions or reversals are increasing in public hospitals; and (3) an increasing number of the revision or reversal procedures in public hospitals are for weight loss procedures that have occurred outside the public system. What are the implications for practitioners? The data have implications for practitioners caring for patients interested in undergoing bariatric surgery for the treatment of obesity. The data suggest that rates of revisions or reversals are increasing in public hospitals, which suggests that further information is needed regarding the effectiveness of weight loss procedures and the implications of revision or reversal increases on waiting times for patients seeking weight loss treatment in a system with limited resources.

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Healthcare Utilization and Outcomes After Bariatric Surgery

Cited by 162 publications

References 14 publications

Costs and usage of healthcare services before and after open bariatric surgery

Costs and usage of healthcare services before and after open bariatric surgery

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

Quantitative analysis of bariatric procedure trends 2001–13 in South Australia: implications for equity in access and public healthcare expenditure

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