“The benefits of the surgery outweigh the costs, because the surgery results in a weight reduction that can resolve costly diseases in the patients such as diabetes, hypertension, and sleep apnea.”

RELATED: ESI Special Topic of Bariatric Surgery

Bariatric surgery for weight reduction is one of the fastest growing medical procedures in hospitals, growing in use by 800% between 1998 and 2004. Our paper is the first population-based study to track bariatric patients for six months post-surgery. We documented a surprisingly high complication rate of 40%.

This is a new discovery. Most past studies were not population-based, but were small studies from self-reported physician registries and generally reported a 10% to 20% complication rate. Our study was population-based in that it examined all bariatric patient insurance claims across the country from 45 large employers.

While the complication rate was 21.9% during the initial surgical stay, the rate increased to 39.6% over the 180 days following discharge. 11% of the patients without 30-day complications developed a complication between 30 days and 180 days.

The good news is that we find that the six-month inpatient death rate following bariatric surgery is low (two deaths out of 1,000 surgeries). The bad news is that the six-month complication rate is high (40 out of 100).

These complications result in readmissions and ER visits. The complications range in severity from infections and internal bleeding, to nausea, vomiting, and diarrhea. Some complications, like abdominal hernias, can take months to develop.

Various state Medicaid agencies, which cover the poor and disabled, reported to our agency (AHRQ) that they were concerned because they were seeing higher rates of bariatric complications than reported in the literature. They were considering whether they should drop coverage of bariatric surgery. Moreover, Medicare, which covers the elderly, needed input into its decision whether to cover bariatric surgery.

Thus, we engaged in this research to inform these public agencies. We did encounter negative feedback from bariatric surgeons, who were concerned that these findings would bring a setback to the field of bariatric surgery. However, no setback has occurred. At worst, we expect that poorly performing surgeons will exit the field of bariatrics.

We find that these complications can be quite expensive for society. Total six-month risk-adjusted health care payments were $65,000 for those with readmissions and complications, compared to $27,100 for those without readmissions.

However, we do not suggest that insurers drop coverage of bariatric surgery. The benefits of the surgery outweigh the costs, because the surgery results in a weight reduction that can resolve costly diseases in the patients such as diabetes, hypertension, and sleep apnea.

We would encourage insurers to maintain coverage and channel patients to surgeons and institutions with documented low rates of complications and readmissions. We also believe that patients and their physicians can use the findings from our study to better inform decisions about undergoing bariatric surgery.