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Patients have increased hospitalization rate after gastric bypass surgery

Patients who have gastric bypass surgery have double the rate of hospitalization in

the year following the operation than in the year preceding surgery, according to a study in

the October 19 issue of JAMA.

Bariatric surgical procedures are an increasingly common treatment for morbid obesity,

according to background information in the article. More than 100,000 Roux-en-Y

gastric bypasses (RYGB)--the primary bariatric procedure now done--are performed

annually in the United States. A recent systematic review and meta-analysis of bariatric

procedures determined that the average percentage of excess weight loss after

operation was 61 percent, with rates of resolution or improvement for the following

co-existing illnesses: diabetes 86 percent, hyperlipidemia 70 percent, hypertension

79 percent, and obstructive sleep apnea 84 percent. Utilization of inpatient services

after RYGB is not well understood.

David S. Zingmond, M.D., Ph.D., of the University of California, Los Angeles, and

colleagues assessed the impact of RYGB on use of inpatient care by examining

rates of inpatient hospitalization before and after RYGB performed in California

between 1995 and 2004.

In California from 1995-2004, a total of 60,077 California residents underwent RYGB

for obesity, with 11,659 in 2004. The average age was 42.2 years, 84 percent of

patients were women, and 88 percent were privately insured or self-pay. Average

length of stay was 3.5 days. For patients with a year of follow-up (1995-2003), 19.3

percent were readmitted within the first year after RYGB surgery compared with 7.9

percent being admitted in the year before surgery. In a subset analysis of all patients

(24,678) who underwent RYGB with complete 3-year follow-up, the average percentage

of patients admitted in the year prior to RYGB was 8.4 percent. In each of the 3 years

following RYGB, the rates of hospitalization remained increased, with 20.2 percent of

patients readmitted in the first year after RYGB, 18.4 percent in the second year after,

and 14.9 percent in the third year after. The cumulative admission rate for the 3-year

period prior to RYGB was 20.2 percent compared with the cumulative 3-year admission

rate after RYGB of 40.4 percent.

For persons with 3 years of follow-up, average hospital charges were $33,672 for

RYGB, $4,970 for hospitalizations in the 3 years before RYGB, and $20,651 for

hospitalizations in the 3 years after RYGB. In the subset of patients with full 5 years

of follow-up (1995-1999), postoperative admission rates remained elevated

(average 13.3 percent) in the fifth year after operation.

The most common reasons for admission prior to RYGB were obesity related problems

(e.g., osteoarthritis, lower extremity cellulitis), and elective operation (e.g., hysterectomy),

while the most common reasons for admission after RYGB were complications often

thought to be procedure related, such as ventral hernia repair and gastric revision.

"A working hypothesis in our study was that use of health care services should likewise

improve, namely that inpatient care should decrease after RYGB. However, we found

significant and sustained increases in the rates of hospital admission for morbidly obese

patients after RYGB. Annual rates of hospital admission after RYGB are double than prior

to operation and are sustained beyond a year in this population-based study," the

authors write.

"Our findings may have implications for payers and purchasers of health care. Rather

than expecting a decrease in inpatient health care utilization after RYGB, the costs

associated with inpatient hospitalization may remain elevated for as many as 5 years

following RYGB. Analysis of 3-year charges before and after RYGB suggest that costs

of post-RYGB-related procedures and complications may be 40 percent to 60 percent

of the costs of RYGB itself."

"The potential of RYGB for yielding long-term weight reduction and alleviation of

obesity-related comorbid illnesses has significantly increased the rates of RYGB

over the past decade. Despite these potential benefits, the current study demonstrates

that the rates of hospitalization doubles in the years after operation and that many of

these admissions are directly attributable to this procedure," the researchers conclude.

(JAMA.2005; 294:1918-1924)

Editor's Note: Dr. Zingmond is funded by a Mentored Clinical Scientist Award from the

National Institute on Aging. Co-author Dr. McGory is funded by the Robert Wood

Johnson Clinical Scholars Program at the University of California Los Angeles.

Rachel Champeau

JAMA and Archives Journals

http://www.jamamedia.org

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