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Bariatric surgery risk varies among hospitals, study finds

August 01, 2012|By Nika Soon-Shiong | Los Angeles Times
  • Hospitals that perform the most bariatric surgeries had the best outcomes, according to a new study by Healthgrades.
Hospitals that perform the most bariatric surgeries had the best outcomes,… (Brian Vander Brug / Los Angeles…)

Twenty years from now, 2 out of 5 Americans will be obese, according to the American Journal of Preventive Medicine. For many of these people, dieting and exercise will not be enough to help them lose weight. They may need bariatric surgery.

And if you wind up being one of them, your best bet is to go to a hospital that performs a high volume of bariatric surgeries, according to a new study from Healthgrades, an independent healthcare ratings company based in Denver.

Bariatric surgery alters digestion to both increase metabolism and lower blood sugar levels. It does more to improve obesity-related health issues than liposuction, which simply removes excess fat under the skin. Bariatric surgery often leads to a long-term resolution of diabetes. It also reduces sleep apnea, hypertension and cholesterol as well as the risk of heart disease and stroke.

“Bariatric surgery is a reasonable option to improve your quality of life and potentially lifespan,” said Dr. Arshad Rahim, vice president of accelerated clinical excellence at Healthgrades, who wrote the study.

As the obesity epidemic has grown, so too has the number of bariatric surgeries performed in the U.S. There were 13,386 such procedures in 1998; by 2009, that figure had jumped to 220,000. To qualify for the surgery, a candidate typically must have a body mass index (BMI) of at least 40 or a BMI of at least 35 along with an obesity-related health problem.

There are two types of bariatric surgery. Restrictive procedures reduce the size of a patient’s stomach in order to reduce caloric intake, while gastric bypass operations change the way the body absorbs nutrients by attaching the stomach to the middle of the small intestine, allowing food to bypass the part of the small intestine that absorbs the most calories. For the study, Rahim examined data on bariatric surgeries performed in 478 hospitals across 19 states between 2008 and 2010. He divided the hospitals into three categories:

*105 hospitals were given 1-star ratings. In these hospitals, 11.79% of patients who had bariatric surgery experienced complications.

*265 hospitals were given 3-star ratings. In these hospitals, 5.49% of patients had complications from their bariatric surgeries.

*108 hospitals were given 5-star ratings. Only 3.03% of patients in these hospitals had complications.

Overall, patients treated in 5-star hospitals were 72% less likely to experience complications than patients treated in 1-star hospitals, the study found. Patients in 5-star hospitals were also discharged half a day earlier than patients in 1-star hospitals.

The study highlights the considerable risks of bariatric surgery. The most common complications are respiratory problems such as pulmonary insufficiency and lung collapse. In addition, short-term surgical and post-operative risks include respiratory infection, hemorrhage and death. Long-term risks include nutrition deficiency and complications that may require future surgery.

The volume of bariatric surgery patients per hospital was found to be a strong indicator of the amount of risk-adjusted complications. Hospitals that treated 375 or more patients during a 3-year period had 3% fewer complications than expected. However, hospitals with the lowest patient volume had 42% more complications than expected.

Altogether, patients died in the hospital in 1 out of every 1,740 cases, which is considered low, according to the report.

The study found that California is the most expensive state for bariatric surgery, where the average procedure costs $52,280 per patient.

Patients who need weight-loss surgery should “look for a facility that has a 5-star Healthgrades rating,” Rahim said. “Ask about the number of procedures performed both at the facility and by the surgeon. Make sure you do your research beyond just speaking to family and friends.”

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