Hospital matters in complication rates and lengths of stay for bariatric surgery

The number of bariatric surgeries in the U.S. skyrocketed from 13,386 in 1998 to 220,000 in 2008, but a new study released today by HealthGrades, the leading independent healthcare ratings organization, finds that the nation's hospitals have wide variances in both complication rates and lengths of stay, which largely correlate with the number of times the hospital performs bariatric procedures.

According to the study, patients undergoing bariatric surgery at hospitals rated with 5 stars by HealthGrades experienced, on average, 43% fewer complications and 10% less time in the hospitals than patients at average hospitals.

"Bariatric surgery has been proven to reduce caloric intake and control obesity, but the HealthGrades study demonstrates that where patients have this type of surgery matters - a great deal," said Rick May, MD, a vice president with HealthGrades and a co-author of the study. "There is a subset of U.S. hospitals whose patients, the data show, routinely have fewer complications and leave the hospital earlier."

The fifth annual HealthGrades Bariatric Surgery Trends in American Hospitals Study released today examines trends in bariatric surgery as well as analyzes patient outcomes at each of the 684 hospitals that perform the surgery in the 19 states that collect patient-outcomes data. The quality ratings of each hospital are based on risk-adjusted, inhospital complication rates and are available at www.healthgrades.com along with the full study.

Hospitals receiving a 5-star rating in bariatric surgery have complication rates that are, to a statistically significant degree, lower than expected based on their patient population. Hospitals receiving a 3-star rating performed as expected, and those receiving a 1-star rating have complication rates that are higher than expected to a statistically significant degree. Hospitals with patient outcomes in the top 10% in the nation received the 2010/2011 HealthGrades Bariatric Surgery Excellence Award™.

The study found that:
•Patients having bariatric surgery at 5-star rated hospitals are 42.66% less likely to experience inhospital complications than patients at 3-star rated programs, and 66.55% less likely compared to 1-star rated programs.
•Five-star rated hospitals had an average case volume of 646 surgeries performed over three years, while 1-star rated hospitals averaged 384 cases.
•While inhospital mortality is generally an uncommon complication, patients had , on average, a four times higher risk of dying if they had a bariatric surgery performed at 1-star rated hospitals compared to 5-star rated hospitals.
•If all bariatric programs from 2006 through 2008 had performed at the level of 5-star rated hospitals, 5,046 patients could have potentially avoided a major inhospital complication across the 19 states studied.
•Patients having surgery at 5-star rated hospitals spent, on average, less time in the hospital (2.00 days) compared to patients treated in 3-star rated hospitals (2.21 days), and almost a half a day less than patients having surgery in 1-star rated hospitals (2.48 days).
•Bariatric Centers of Excellence (COE) programs were more likely to receive a 5-star rating than non-COE programs (25.6% of COE programs were 5-star rated while only 10.9% of non-COE programs received a 5-star rating).

Other findings from HealthGrades study include:
•Over the three years studied, 2006, 2007 and 2008, the number of bariatric surgeries in the 19 states analyzed increased 16%.
•In 2006, less-invasive laparoscopic procedures represented 83.18% of all procedures, and by 2008 they represented 88.93% of all bariatric procedures. On average, laparoscopic procedures had a complication rate of 5.49%, while gastric bypass procedures had a complication rate of 11.64%, and malabsorptive procedures had a complication rate of 7.01%.
•Of the 19 states studied, 63.33% of all procedures were performed in five states: California, New York, Texas, Pennsylvania and Florida.
•Overall, bariatric surgery patients were charged, on average, $38,254 for a laparoscopic procedure, while the average charge for an open procedure (e.g., gastric bypass or malabsorptive) was $38,323.
•Of all patients, 6.57% paid for their surgery out-of-pocket (self-pay) and did not utilize any type of insurance. There was a 5.42% decrease in the number of self-pay patients from 2006 through 2008.

Bariatric surgery is recognized as an effective treatment for obesity, especially in those patients noted to have extreme obesity, also referred to as "morbid obesity." Morbid obesity carries an extensive risk of life-threatening complications such as heart disease, diabetes and high blood pressure. Morbid obesity affects approximately 4.7% of the U.S. population, according to the Centers for Disease Control.

Methodology
For this study, HealthGrades analyzed 190,502 bariatric procedures performed in the years 2006, 2007 and 2008. The states included in the study are: Arizona, California, Colorado, Florida, Iowa, Maine, Maryland, Massachusetts, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington, and Wisconsin.

To make accurate and valid comparisons of clinical outcomes at different hospitals with different patient characteristics, HealthGrades risk adjusted the data using multivariate logistic regression to account for age, gender and underlying medical conditions that could increase the patient's risk of mortality or complication. The full study and individual hospital ratings for bariatric surgery and other procedures can be found at www.healthgrades.com.

Individuals contemplating bariatric surgery will find both quality and cost information at www.healthgrades.com. In addition to the hospital-quality ratings, website visitors can also research surgeons who perform bariatric surgery as well as medical cost reports that detail all of the costs, including out-of-pocket expenses, for the procedure.