Background
To determine which (if any) pre-surgery obesity-related co-morbidities predict complications after bariatric surgery.
Methods
Claims data are analyzed for 1,760 patients aged 18–62 who were covered by one of seven New York State health plans and underwent bariatric surgery during 2002–2005. Data covered 6 months before to 18 months after surgery. Pre-surgery obesity-related comorbidities studied include: diabetes, hyperlipidemia, hypertension, asthma, arthritis, sleep apnea, GERD, and depression. Specific post-surgery complications examined are: stenosis, complications associated with the anastomosis, dumping syndrome, and sepsis.
Results
Obesity-related co-morbidities prior to surgery are significantly correlated with the probability of developing complications up to 180 days after bariatric surgery. For example, sepsis was significantly more likely in patients who had diabetes, arthritis, or sleep apnea prior to surgery. An additional pre-surgery comorbidity is associated with a 27.5% higher likelihood of dumping syndrome, 24.5% higher likelihood of complications associated with the anastomosis, and 23.5% higher probability of sepsis in the first 180 days after surgery. Among the individual co-morbidities studied, sleep apnea and GERD are most predictive of complications.
Conclusion
Patients who exhibit multiple obesityrelated co-morbidities prior to bariatric surgery are at significantly elevated risk of post-surgery complications and merit closer monitoring by health care professionals after bariatric surgery. Limitations of this study include nonexperimental data and an unknown degree of under underreporting of pre-surgery co-morbidities in claims data.
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References
Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med 2003; 163: 2146–8.
Ogden CL, Carroll MD, Curtin LR et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295: 1549–55.
Field, AE, Barnoya J, Colditz GA. Epidemiology and health and economic consequences of obesity. In: Wadden TA, Stunkard AJ, eds. Handbook of Obesity Treatment. New York: Guilford Press 2002.
Pi-Sunyer FX. Medical complications of obesity in adults. In: Fairburn CG, Brownell KD, eds. Eating Disorders and Obesity: A Comprehensive Handbook, 2nd Edition. New York: Guilford Press 2002.
Manson JE, Skerrett PJ, Willett WC. Epidemiology of health risks associated with obesity. In: Fairburn CG, Brownell KD, eds. Eating Disorders and Obesity: A Comprehensive Handbook, 2nd Edition. New York: Guilford Press 2002.
Thorpe KE, Florence CS, Howard DH et al. The impact of obesity on rising medical spending. Health Affairs, October 20, 2004; W4–480.
Finkelstein E, Fiebelkorn I, Wang G. National medical spending attributable to overweight and obesity: how much and who’s paying? Health Affairs Web Exclusive, May 14, 2003.
Sturm R. The effects of obesity, smoking and drinking on medical problems and costs. Health Affairs 2002; 21: 245–53.
Allison DB, Zannolli R, Venkat Narayan KM. The direct health care costs of obesity in the United States. Am J Public Health 1999; 89: 1194–9.
Wolf A, Colditz G. Current estimates of the economic cost of obesity in the United States. Obes Res 1998; 6: 97–106.
U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edn. Washington, DC: U.S. Government Printing Office 2000.
Mitka M. Surgery useful for morbid obesity, but safety and efficacy questions linger. JAMA 2006, 296: 1575–7.
Wolfe BM, Morton JM. Weighing in on bariatric surgery: procedure use, readmission rates and mortality. JAMA 2005; 294: 1960–3.
Buchwald H, Avidor Y, Braunwald E et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 14: 1724–37.
Cawley J, Prinz T, Beane S et al. Health insurance claims data as a means of assessing reduction in comorbidities six months after bariatric surgery. Obes Surg 2006; 16: 852–8.
Pope GD, Birkmeyer JD, Finlayson SRG. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg 2002; 6:855–60.
Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgery procedures. JAMA 2005; 294: 1909–17.
Courcoulas AP, Flum DR. Filling the gaps in bariatric surgical research. JAMA 2005; 294: 1957–60.
Mitka M. Surgery for obesity: demand soars amid scientific, ethical questions. JAMA 2003; 289: 1761–2.
Hauri P, Horber FF, Sendi P. Is bariatric surgery worth its costs? Obes Surg 1999; 9: 480–3.
Shekelle P, Morton S, Maglione M et al. Pharmacological and Surgical Treatment of Obesity, Evidence Report/Technical Assessment #103. Prepared by the Southern California-RAND Evidence-Based Practice Center, Santa Monica CA for the Agency for Healthcare Research and Quality 2004.
Maggard MA, Shugarman LR, Sutorp M et al. Metaanalysis: surgical treatment of obesity. Ann Intern Med 2005; 7: 547–59.
Encinosa WE, Bernard DM, Chen C-C et al. Healthcare utilization and outcomes after bariatric surgery. Med Care 2006; 44: 706–12.
Snow V, Barry P, Fitterman N et al. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2005; 142: 525–31.
Sugerman HJ. Response to an article in the August 2006 issue of Medical Care. Med Care 2006; 44: 1059.
Weller WE, Hannan EL. Relationship between provider volume and postoperative complications for bariatric procedures in New York State. J Am Coll Surgeons 2006; 202: 753–61.
Nguyen NT, Silver M, Robinson M et al. Result of a National Audit of Bariatric Surgery Performed at Academic Centers. Arch Surg 2006; 141: 445–50.
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The New York State Bariatric Surgery Workgroup members: Betsy Mulvey, New York Health Plan Association; Joseph Chiarella, MD, HealthNet; Clifford R. Waldman, MD, Capital District Physicians’ Health Plan; David Finley, MD, Oxford Health Plan; Carolyn Leihbacher, MD, Hudson Health Plan; Margaret Leonard, Hudson Health Plan; Anthony Mangiapane, MD, MVP Health Care; Pamela J. Scanlon, MVP Health Care; Bradley Truax, MD, Independent Health; Ed Anslem, MD, HIP; S Ramalingam, MD, Preferred Care; Amin Hakim, MD, GHI; Philip Smeltzer, MD, Health Now; Marie Casalino, MD, Fidelis Care; Collin E. M. Brathwaite, MD, St. Catherine of Siena Medical Center; Christine J. Ren, MD NewYork University School of Medicine; Oscar C. Lirio, MD, Ellis Hospital; LD George Angus, MD, Nassau County Medical Center
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Cawley, J., Sweeney, M.J., Kurian, M. et al. Predicting Complications after Bariatric Surgery using Obesity-Related Co-morbidities. OBES SURG 17, 1451–1456 (2007). https://doi.org/10.1007/s11695-008-9422-1
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DOI: https://doi.org/10.1007/s11695-008-9422-1