Health care utilization and expenditure changes associated with bariatric surgery.

CONTEXT: Bariatric surgery provides significant reductions in weight and comorbidity, and has the potential to reduce health care utilization. It is unknown whether health care utilization and expenditures are reduced for veterans after bariatric surgery. OBJECTIVES: To examine health care utilization and expenditures of severely obese individuals before and after bariatric surgery within the Veterans Health Administration. DESIGN, SETTING, AND PATIENTS: We conducted a retrospective, longitudinal cohort study of health care use and expenditures among all veterans who underwent bariatric surgery in 1 of 12 approved Department of Veterans Affairs bariatric centers from 2000 to 2006. Bariatric patients were identified via Current Procedural Terminology-4 codes from a database of major surgical procedures maintained by the National Surgical Quality Improvement Program. MAIN OUTCOME MEASURE: The main outcomes of interest for our analysis were multivariable adjusted inpatient and outpatient health care utilization and expenditures in the 3 years prior to surgery and in the 3 years after surgery. RESULTS: Between 2000 and 2006, 846 veterans had bariatric surgery, 25% of whom underwent a laparoscopic procedure. The mean initial body mass index was 48.5, the mean age was 51; and 73% were male. In multivariable models including all years of data, outpatient, inpatient, and overall expenditures significantly decreased in the years after surgery because of higher clinical resources required in the months before and during surgery. When excluding the 6 months leading up to surgery and the 6 months just after surgery, outpatient expenditures remained lower in the postsurgical period, but inpatient and overall expenditures were significantly higher. CONCLUSION: Our analyses indicate that this cohort of older, male bariatric surgery patients does not achieve a reduction in health care expenditures 3 years after their procedure. These results are at variance from other, similar published studies and may reflect differences in study populations or systems of care.

Duke Scholars

Author Matthew Leonard Maciejewski Population Health Sciences

Author Valerie A. Smith Population Health Sciences