Feature Story

Obesity surgery complication rates are higher over time

Four of every 10 patients who have obesity surgery (also known as bariatric or weight loss surgery) develop a complication within 6 months of leaving the hospital. This new study by the Agency for Healthcare Research and Quality (AHRQ), based on insurance claims data, is the most extensive to date on postsurgical complications from obesity operations.

AHRQ researchers William Encinosa, Ph.D., Didem Bernard, Ph.D., and Claudia Steiner, M.D., M.P.H., found that the complication rate among privately insured, nonelderly patients receiving obesity surgery increased from 21.9 percent while they were still hospitalized to 39.6 percent by the end of the 180-day study period.

The five most common complications were dumping syndrome, which includes vomiting, reflux, and diarrhea (nearly 20 percent); anastomosis complications (complications resulting from the surgical joining of the intestine and stomach), such as leaks or strictures (12 percent); abdominal hernias (7 percent); infections (6 percent); and pneumonia (4 percent). The overall death rate for the entire 180-day postoperative period studied was low—0.2 percent.

Complications from obesity surgery also increased costs. Medical care spending averaged $36,542 for obesity surgery patients who experienced a complication up to 180 days after surgery, including their initial hospital stay; spending for patients without complications averaged $25,337. In addition, medical care spending for patients who had to be readmitted because of a complication during the 180-day period averaged $65,031 compared with $27,125 for those who did not have to be hospitalized again.

Most studies of complications from obesity surgery have been limited to those that occur before hospital discharge or, at the most, up to 30 days post-discharge. As noted, the new study extends the observation period up to 180 days—6 months—after hospital discharge.

The researchers also analyzed differences between 30-day and 180-day postoperative complication rates. They found that 10.8 percent of patients who had not experienced a complication within 30 days did so in the following 150 days. During this same 30-day period, the proportion of patients who had to be readmitted to hospitals with complications increased by 50 percent—from 4.8 percent to 7.2 percent.

These findings were based on claims for hospital care and outpatient care for 5.6 million enrollees under age 65 in employer-sponsored health plans for 45 large employers in 49 States for 2001 and 2002. The claims data included information on 2,522 bariatric procedures.

More details are in "Healthcare utilization and outcomes after bariatric surgery," by Drs. Encinosa, Bernard, and Steiner, in the August 2006 Medical Care 44(8), pp. 706-712. Reprints (AHRQ Publication No. 06-R068) are available from the AHRQ Publications Clearinghouse.

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