Probing problems with bariatric surgery: Reoperations, variation are common

May 23, 2017
The laparoscopic adjustable gastric band form of bariatric surgery is less common today than in previous years, but new research shows nearly 1 in 5 Medicare patients who had had it between 2006 and 2013 needed a second operation. Credit: University of Michigan

Every year, nearly 200,000 Americans turn to surgeons for help with their obesity, seeking bariatric surgery to lose weight and prevent life-threatening health problems.

But after more than two decades of steadily increasing numbers of operations, American centers still vary greatly in the quality of care they provide.

That's the finding of a team of researchers at the University of Michigan who used data from insurers that pay for bariatric operations, and from a statewide partnership of bariatric surgery teams, to study the issue of bariatric surgery outcomes.

Just in the past few months, the U-M team has published several papers that shed new light on the high level of variability and incidence of complications that patients still face.

"As Americans turn to bariatric and metabolic operations in higher and higher numbers, and as our county grapples with the ongoing obesity epidemic, it's more important than ever to take a clear-eyed look at how well our surgical centers are doing, and to try to improve the care patients receive," says Andrew M. Ibrahim, M.D., M.Sc., the Robert Wood Johnson Clinical Scholar and U-M surgical resident who led many of the new studies as part of his work at the U-M Center for Healthcare Outcomes and Policy.

Their most recent findings:

Nearly 1 in 5 patients with Medicare who have laparoscopic adjustable gastric band surgery will end up needing at least one more device-related operation, either to remove or replace the band around the upper portion of their stomach, or to switch to a different stomach-remodeling approach. The results were published in JAMA Surgery.

Additional device-related procedures for the operation were so common, in fact, that nearly half (47%) of the $470 million paid by Medicare for such procedures was for reoperations to revise or remove it. "If half the money we're spending on a device is to revise or remove it, we ought to ask ourselves if we should still be using it," says Ibrahim.

Though this form of bariatric surgery has declined sharply in popularity in recent years, and now makes up only about five percent of all operations, there are still hundreds of thousands of people who have the devices from past operations. So failure of the devices to result in weight loss, or complications from their placement, pose a potential major issue. The study finds tremendous variation between surgical centers in the rate of reoperation that their patients faced.

The new study looks at data from 25,042 people who had operations between 2006 and 2013, and who were covered by Medicare, which pays for about 15 percent of all bariatric operations.

Another recent paper from the U-M team finds that even accredited bariatric "centers of excellence" can vary greatly in the rate of complications their patients suffer after their operations.

Published in JAMA Surgery, the study looked at data from more than 145,500 patients and found a 17-fold difference between the centers with the highest and lowest rates of serious complications. It found that even within a single state, one bariatric surgery center can have nine times the complication rate of another center.

"While we have made significant progress improving the safety of bariatric surgery over the last two decades, the presence of 17-fold variation in complications rates across accredited centers underscores that we need to improve further," Ibrahim notes.

The team also recently studied how variations in quality affect the cost of care, which ultimately affects both the premiums paid by those with private insurance, and public costs for the care of people who have operations paid for by Medicare and Medicaid.

They looked at data from 38,374 patients covered by Medicare for bariatric surgery between 2011 and 2013, and found that hospitals with the lowest complication rates perform bariatric procedures for $1,321 less per patient than hospitals with the highest complication rates. When they focused on patients with additional risk factors that made them more prone to surgical complications, that difference grew to more than $2,600 per patient.

So, the researchers conclude in the paper in Annals of Surgery, efforts to improve bariatric quality could significantly affect not only , but also the cost of care.

Explore further: Following gastric band surgery, device-related reoperation common, costly

More information: Andrew M. Ibrahim et al, Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery, JAMA Surgery (2017). DOI: 10.1001/jamasurg.2017.1093

Related Stories

Following gastric band surgery, device-related reoperation common, costly

May 17, 2017
Among Medicare beneficiaries undergoing laparoscopic adjustable gastric band surgery, reoperation was common, costly, and varied widely across hospital referral regions, according to a study published by JAMA Surgery.

Pre-pregnancy bariatric surgery ups risk of abdominal surgery

April 18, 2017
(HealthDay)—Bariatric surgery is associated with an increased risk of abdominal surgery during subsequent pregnancy, according to a study published in the May issue of Obstetrics & Gynecology.

Patients at accredited bariatric surgical centers have fewer postoperative complications

July 12, 2016
Patients who have weight-loss operations at nonaccredited bariatric surgical facilities in the United States are up to 1.4 times likelier to experience serious complications and more than twice as likely to die after the ...

Bariatric surgery tied to T2DM resolution in obese patients

February 16, 2017
(HealthDay)—Five years after bariatric surgery, patients with type 2 diabetes who have the procedure show better improvements in quality of life and overall health, compared with those who only take diabetes medications, ...

Medicare Center of Excellence Policy may limit minority access to weight-loss surgery

September 12, 2013
Safety measures intended to improve bariatric surgery outcomes may impede obese minorities' access to care. This is according to a new research letter published online in the September 12 issue of JAMA which compares rates ...

Recommended for you

Defining optimal opioid pain medication prescription length following surgery

September 27, 2017
A new study led by researchers at the Center for Surgery and Public Health at Brigham and Women's Hospital analyzed opioid prescription data from the Department of Defense Military Health System Data Repository, identifying ...

Is older blood OK to use in a transfusion?

September 27, 2017
(HealthDay)—Using older red blood cells to give transfusions to critically ill patients doesn't appear to affect their risk of dying, Australian researchers report.

One weight-loss surgery shows lasting results

September 21, 2017
(HealthDay)—Obesity surgery can have long-lasting effects on weight and the risk of developing type 2 diabetes and high blood pressure, a new study finds.

Hold the phone: An ambulance might lower your chances of surviving some injuries

September 20, 2017
Victims of gunshots and stabbings are significantly less likely to die if they're taken to the trauma center by a private vehicle than ground emergency medical services (EMS), according to results of a new analysis.

Surgeons have major influence on breast cancer treatment

September 13, 2017
A woman's choice of surgeon plays a significant role in whether she's likely to receive an increasingly popular aggressive breast cancer surgery.

Some thyroid cancer patients can safely delay surgery

September 4, 2017
Most people diagnosed with cancer want to start treatment as soon as possible, for fear that delaying care will allow their tumor to grow out of control.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.