Bariatric Surgeries Increase, But Quality, Cost Vary Widely

The number of bariatric surgeries in the United States skyrocketed from 13,386 in 1998 to 220,000 in 2008, but a new study released by HealthGrades, the leading independent healthcare ratings organization, finds that the nation’s hospitals have wide variances in both complication rates and lengths of stay, which largely correlate with the number of times the hospital performs bariatric procedures.

According to the study, patients undergoing bariatric surgery at hospitals rated with 5 stars by HealthGrades experienced, on average, 43% fewer complications and 10% less time in the hospitals than patients at average hospitals.

The study examines trends in bariatric surgery as well as analyzes patient outcomes at each of the 684 hospitals that perform the surgery in the 19 states that collect patient-outcomes data. The quality ratings of each hospital are based on risk-adjusted, inhospital complication rates.

The study found that:

• Patients having bariatric surgery at 5-star rated hospitals are 42.66% less likely to experience inhospital complications than patients at 3-star rated programs, and 66.55% less likely compared with 1-star rated programs.

• Five-star rated hospitals had an average case volume of 646 surgeries performed over three years, while 1-star rated hospitals averaged 384 cases.

• While inhospital mortality is generally an uncommon complication, patients had , on average, a four times higher risk of dying if they had a bariatric surgery performed at 1-star rated hospitals compared to 5-star rated hospitals.

• If all bariatric programs from 2006 through 2008 had performed at the level of 5-star rated hospitals, 5,046 patients could have potentially avoided a major inhospital complication across the 19 states studied.

• Patients having surgery at 5-star rated hospitals spent, on average, less time in the hospital (2 days) compared with patients treated in 3-star rated hospitals (2.21 days), and almost one half a day less than patients having surgery in 1-star rated hospitals (2.48 days).

• Bariatric Centers of Excellence programs were more likely to receive a 5-star rating than non-COE programs (25.6% of COE programs were 5-star rated while only 10.9% of non-COE programs received a 5-star rating).

Other findings from HealthGrades study include:

• Over the three years studied, 2006, 2007 and 2008, the number of bariatric surgeries in the 19 states analyzed increased 16%.

• In 2006, less-invasive laparoscopic procedures represented 83.18% of all procedures, and by 2008 they represented 88.93% of all bariatric procedures. On average, laparoscopic procedures had a complication rate of 5.49%, while gastric bypass procedures had a complication rate of 11.64%, and malabsorptive procedures had a complication rate of 7.01%.

• Of the 19 states studied, 63.33% of all procedures were performed in five states: California, New York, Texas, Pennsylvania, and Florida.

• Overall, bariatric surgery patients were charged, on average, $38,254 for a laparoscopic procedure, while the average charge for an open procedure (eg, gastric bypass or malabsorptive) was $38,323.

• Of all patients, 6.57% paid for their surgery out-of-pocket (self-pay) and did not utilize any type of insurance. There was a 5.42% decrease in the number of self-pay patients from 2006 through 2008.

Source: HealthGrades