Bariatric Surgical Procedures Increase Substantially
The number of bariatric surgical procedures performed in the U.S. from 1998 to 2003 increased considerably, according to a study in the October 19 issue of JAMA.
Morbid obesity is an increasing health problem in the United States, according to background information in the article. In 2002, 5.1 percent of U.S. adults had a body mass index (BMI) higher than 40. The prevalence of individuals with a BMI higher than 40 quadrupled from 1:200 in 1986 to 1:50 in 2000; the prevalence of individuals with a BMI higher than 50 quintupled from 1:2000 to 1:400. The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity.
Heena P. Santry, M.D., of the University of Chicago, and his colleagues examined recent national population-based trends in bariatric surgical procedures, patient characteristics, and in-hospital complications to determine trends in newer techniques, in sociodemographic disparities, in co-existing illnesses, and in surgical complications due to these procedural and patient population changes. The scientists used the Nationwide Inpatient Sample to identify U.S. bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states for 2003).
The scientists found that the estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002. Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102,794 in 2003. Gastric bypass procedures accounted for more than 80 percent of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81 percent to 84 percent), privately insured patients (75 percent to 83 percent), patients from ZIP code areas with highest annual household income (32 percent to 60 percent), and patients aged 50 to 64 years (15 percent to 24 percent). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002. The adjusted in-hospital death rate ranged from 0.1 percent to 0.2 percent. The rates of unexpected reoperations for surgical complications ranged from 6 percent to 9 percent and pulmonary complications ranged from 4 percent to 7 percent. Rates of other in-hospital complications were low.
"If our observed rate of growth continues, there will be approximately 130,000 bariatric procedures in 2005 and as a number of as 218,000 in 2010. The cost to the U.S. health care system will be substantial. However, in the absence of a nonsurgical option for morbid obesity, our findings regarding in-hospital safety of bariatric surgery are promising while our findings regarding worsening sociodemographic disparities are worrisome," the authors write.
"Disproportionate sociocultural pressures to be thin may explain the imbalance between men and women undergoing an elective procedure for weight loss. Type of insurance coverage also may play a role in socioeconomic disparities," the scientists write. "Other sources of disparities include the possibility that cultural attitudes toward morbid obesity may differ by socioeconomic status, that primary care clinicians may be less likely to refer patients of lower socioeconomic status for bariatric surgery, or that hospitals providing bariatric surgery may be less accessible to lower socioeconomic groups."
The scientists add that public health campaigns focusing on the health dangers of obesity may help shift thinking about obesity from a cosmetic concern of women to a health concern for both sexes.
"With increased knowledge of bariatric surgery indications, risks, and benefits among health care professionals, bariatric surgery is likely to become the standard of care for morbidly obese individuals. Together, these changes should lead to more morbidly obese patients of both sexes and all socioeconomic groups seeking surgery. Eventhough preventing obesity should remain the focus of U.S. health care, efforts must be made to ensure equal access to bariatric surgery irrespective of sex and socioeconomic status for those who are morbidly obese, have an indication for surgical intervention, and wish to undergo an elective surgical procedure to improve health, longevity, and quality of life," the authors conclude.
(JAMA. 2005;294:1909-1917. Available pre-embargo to the media at www.jamamedia.org).
Editor's Note: Dr. Santry was supported by a fellowship from the Robert Wood Johnson Clinical Scholars Program and a pilot project grant from the National Institute on Aging to the Center on Aging at the University of Chicago, and the Dr. Paul Jordan Research Fund in Surgery at the University of Chicago.