Weight-Loss Surgery: Patient Qualifications
Gastric Bypass May Not Cut Healthcare Costs
Post operation, bariatric surgery was not linked to lesser healthcare expenses in the past few years.
By Todd Neale, MedPage Today
Medically Reviewed by Robert Jasmer, MD
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MONDAY, July 16, 2012 (MedPage Today) —Among obese veterans, bariatric surgery — predominantly gastric bypass — was not associated with lower healthcare expenditures in the 3 years after the operation, researchers found.
For outpatient, inpatient, and total healthcare spending, there was a spike in the surgical group around the time of the operation followed by a convergence to the levels seen in the nonsurgical group, according to Matthew Maciejewski, PhD, of the Durham VA Medical Center in North Carolina, and colleagues.
The findings contrast with previous observational analyses conducted primarily in younger, predominantly female cohorts that have shown lower healthcare expenditures in the 2 to 5 years following bariatric surgery, the researchers reported in the July issue ofArchives of Surgery.
"Although bariatric surgery was not associated with reduced expenditures in this cohort of older, predominantly male patients, many patients may still choose to undergo bariatric surgery given the strong evidence of significant reductions in body weight and comorbidities and improved quality of life," they wrote.
Maciejewski and colleagues retrospectively examined data on veterans who underwent bariatric surgery from 2000 to 2006 at one of 12 VA medical centers. Nearly all of the procedures (97 percent) were Roux-en-Y gastric bypasses, and the rest were vertical banded gastroplasty.
The researchers used propensity scoring to match 847 veterans who underwent surgery to 847 veterans who did not.
Before matching, the mean age of the surgical patients was 49.5. About three-quarters of the were male and white. The average body mass index was 47.4 kg/m2 with about one-third of the patients having a BMI of 50 kg/m2 or greater.
3 years before the operation (or index date), healthcare expenditures were similar in the surgical and nonsurgical groups. As the operation date approached, the gap widened, with greater spending in the surgical group. Following a spike at the time of the operation, healthcare expenditures converged in the two groups.
The difference in outpatient expenditures, for example, ranged from 3 higher in the surgical group at 2.5 to 3 years before the operation to ,758 higher in the surgical group in the 6 months before surgery. The gap then closed, dropping from ,223 in the first 6 months after surgery to 2.5 to 3 years after surgery.
Similar trends were seen for inpatient and total healthcare expenditures.
The jump in spending around the time of surgery is expected, according to the researchers, because it is common for patients who ultimately undergo bariatric surgery to gain weight in the year before the procedure, resulting in greater use of resources compared with a time when weight was more stable.
And in addition to the costs of the operation itself, there will be expenditures related to the presurgical workup and evaluation and intense medical weight loss that might be required to lower the risk of surgery.
The failure to see expenditures in the surgical group dip below those in the nonsurgical group after the operation was unexpected, however, because of the results of previous observational studies.
The researchers said that the discrepant results could be related to the higher proportion of males and higher average age in the current study, as well as to differences in identifying and matching nonsurgical controls.
In an invited critique, Harry Sax, MD, of Cedars-Sinai Medical Center in Los Angeles, noted some unanswered questions from the current study, including whether pharmacy costs were reduced with surgery, whether quality of life differed between the two groups, and whether the findings can be extrapolated to current practice, which includes greater use of laparoscopic gastric bands and sleeves.
Another issue to consider, he wrote, is the greater death rate among the nonsurgical controls within 6 years of the index date (12.8 percent versus 6.8 percent).
"In other words, 50 more surgical patients were alive to consume resources during the 6 years studied," he wrote.
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