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BACKGROUND/RATIONALE:
Currently, more than 11 million U.S. adults, including 890,000 veterans, are morbidly obese. Between 1960 and 2002, the prevalence of morbid obesity in the United States rose from 0.8% to 5.1%. The impact of this epidemic is substantial; in 2000, morbid obesity was associated with 82,066 deaths and over $11 billion in direct U.S. health care expenditures. There is now evidence that bariatric (i.e., weight loss) surgery can substantially improve body weight, obesity-associated chronic conditions, and quality of life.
Few studies have demonstrated that bariatric surgery improves long-term health outcomes, such as death and serious complications. The current evidence base for bariatric surgery might not apply to the older, predominantly male population found in the VA because studies have primarily included young female patients. Male patients and those with advanced age may be at greater risk for severe, life-threatening complications of bariatric surgery, and the evidence base for the appropriate use of bariatric surgery in those patients needs to be better understood.
OBJECTIVE(S):
We will examine the impact of bariatric surgery and morbid obesity on survival, health services use, and costs of care in the VA from 2000 to 2005.
METHODS:
Using data collected from year 2000 through 2005, we will compare survival, health care use, and expenditures across two cohorts: 1,029 morbidly obese veterans who had bariatric surgery and 61,513 morbidly obese veterans who did not have bariatric surgery. In addition, among bariatric surgery patients, we will compare preoperative and postoperative health care use and expenditures, and identify patient-level characteristics that are associated with adverse health outcomes.
FINDINGS/RESULTS:
In survival analysis of 856 bariatric cases, we found that super obesity (BMI>50) and being at high risk (DCG risk adjuster>2) were strongly and negatively associated with survival until 12/31/06. Additional analyses are ongoing.
IMPACT:
This study will provide a rigorous assessment of veterans who have undergone bariatric surgery from 2000 to 2005 to provide an evidence base for the health and economic impacts bariatric surgery for morbidly obese veterans. Results of this study will be relevant to patient care in the VA and will assist the VA in meeting three major objectives: 1) improving the generalizability of recommendations in the VA Obesity Clinical Practice Guideline, 2) improving bariatric surgical practice in coordination with the VA Bariatric Surgery Workgroup, and 3) refining the evidence base for surgical treatment in the national VA Managing Obesity for Veterans Everywhere (MOVE!) program.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Resource Use and Cost, Treatment
Keywords:
Quality assessment, Obesity, Outcomes
MeSH Terms:
Outcome Assessment (Health Care)
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