WOW! Please read! WLS peeps often hospitalized post op

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Weight Loss Surgery and Hospitalization Rates

Patients who have gastric bypass surgery (designed to promote weight

loss) 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.

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 loss 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) - Chicago