Effect of Mandatory Centers of Excellence Designation on Demographic Characteristics of Patients Who Undergo Bariatric Surgery

Bae, Junun; Shade, Jaime; Abraham, Amanda J.; Abraham, Brianna; Peterson, Leigh; Schneider, Eric B.; Magnuson, Thomas; Schweitzer, Michael; Steele, Kimberly

doi:10.1001/jamasurg.2015.74

Cited by 24 publications

(13 citation statements)

References 26 publications

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“…Although several studies reporting that patients without private insurance were significantly underrepresented in bariatric surgery [ 31 , 32 ], our finding of the improved access to bariatric surgery for Medicare or Medicaid beneficiaries is encouraging. In a national representative dataset, the percentage of bariatric procedures covered by Medicare rose from 8.5% in 2006 to 16.3% in 2011 [ 33 ], while increasing from 15.8% in 2011 to 19.2% in 2014 in our study. One recent study also reported that patients covered by Medicare or Medicaid are more likely to undergo gastric bypass than privately insured patients [ 34 ].…”

Section: Discussionmentioning

confidence: 50%

Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014

Zhang¹,

Scott²,

Shi³

et al. 2017

PLoS ONE

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BackgroundWith the epidemic of morbid obesity, bariatric surgery has been accepted as one of the most effective treatments of obesity.ObjectiveTo investigate recent changes in the utilization of bariatric surgery, patients and hospital characteristics, and in-hospital complications in a nationwide hospital database in the United States.SettingThis is a secondary data analysis of the Premier Perspective database.MethodsICD-9 codes were used to identify bariatric surgeries performed between 2011 and 2014. Descriptive statistics were computed and regression was used.ResultsA total of 74,774 bariatric procedures were identified from 436 hospitals between 2011 and 2014. During this time period, the proportion of gastric bypass (from 44.8% to 31.3%; P for trend < 0.0001) and gastric banding (from 22.8% to 5.2%; P for trend < 0.0001) decreased, while the proportion of sleeve gastrectomy (from 13.7% to 56.9%; P for trend < 0.0001) increased substantially. The proportion of bariatric surgery performed for outpatients decreased from 17.15% in 2011 to 8.11% in 2014 (P for trend < 0.0001). The majority of patients undergoing surgery were female (78.5%), white (65.6%), younger than 65 years (93.8%), and insured with managed care (53.6%). In-hospital mortality rate and length of hospital stay remained stable. The majority of surgeries were performed in high-volume (71.8%) and urban (91.6%) hospitals.ConclusionsResults based on our study sample indicated that the popularity of various bariatric surgery procedures changed significantly from 2011 to 2014. While the rates of in-hospital complications were stable, disparities in the use of bariatric surgery regarding gender, race, and insurance still exist.

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Section: Discussionmentioning

confidence: 50%

Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014

Zhang¹,

Scott²,

Shi³

et al. 2017

PLoS ONE

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“…Having in view the large number of bariatric procedures performed each year over the past 15 years, national and regional organization of bariatric surgery now constitutes a major issue. Indeed, it needs to plan in terms of access to expert care in each region, [12] individual choice of the most appropriate procedure, supply adapted to the epidemiological context, and health system funding. [3] It should also specifically structure care for teenagers or elderly patients, as well as in case of reoperation.…”

Section: Discussionmentioning

confidence: 99%

Current challenges in providing bariatric surgery in France

et al. 2016

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Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d’Information Inter-régimes de l’Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m2 for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m2, and treatment for obstructive sleep apnea syndrome, diabetes, or depression. Universal health insurance coverage for low-income patients was inversely correlated with the probability of RYGB.Differences in access to surgery have been observed in terms of the patient's profile, geographical variations, and predictors of types of procedures. Several challenges must be met when organizing the medical care of this growing number of patients, when delivering surgery through qualified centers while assuring the quality of long-term follow-up for all patients.

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“…14,15 This suggests the incidence of spine issues as a serious side effect of obesity. Khoueir et al 16 showed that weight reduction after bariatric surgery is potentially associated with a lessening of preexisting back pain.…”

Section: Discussionmentioning

confidence: 99%

Outcomes After Spine Surgery Among Patients Who Have Had Prior Bariatric Surgery

Jensen

Garvey

Dawson

et al. 2018

Global Spine Journal

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Study Design:Retrospective cohort study.Objectives:We hypothesized that spine surgery patients with a history of bariatric surgery do not differ in expectations of surgery, perceived benefit of surgical intervention, or physician determined outcome of surgery from patients with no history of bariatric surgery.Methods:Patients seen in our spine clinic between January 1, 2 009 and December 30, 2 010 were reviewed. Included patients had a history of bariatric surgery and were 18 to 89 years old. We compared their expectations for recovery, self-perceived clinical outcome (Oswestry Disability Index [ODI] or Neck Disability Index [NDI] and visual analog scale [VAS]), satisfaction with surgery, and physician-perceived clinical outcome (Odom’s criteria) to a matched cohort with no such history. Patients were matched by type of surgery (approach, levels, and procedure), diagnosis, sex, body mass index (BMI), weight category, age, and smoking status.Results:Of 210 included patients, 89 underwent spine surgery. One bariatric patient could not be matched. Seventeen received cervical spine surgery; 71 received lumbar spine surgery. The 2 cohorts had similar expectations and satisfaction. Patients with no history of bariatric surgery tended to be more satisfied than the bariatric surgery patients, but not significantly so. ODI/NDI and VAS scores were statistically worse for the bariatric cohort. Differences were attributed to differences among lumbar spine surgery patients; neck surgery patients were not different. Odom’s scores were not different between the two.Conclusions:Postoperative expectations and satisfaction of bariatric patients are similar to those of nonbariatric patients. Bariatric patients receiving lumbar spine surgery experienced inferior clinical outcomes compared with nonbariatric patients. Cervical spine surgery bariatric patients have similar clinical outcomes as nonbariatric patients.

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Effect of Mandatory Centers of Excellence Designation on Demographic Characteristics of Patients Who Undergo Bariatric Surgery

Cited by 24 publications

References 26 publications

Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014

Changes in utilization and peri-operative outcomes of bariatric surgery in large U.S. hospital database, 2011-2014

Current challenges in providing bariatric surgery in France

Outcomes After Spine Surgery Among Patients Who Have Had Prior Bariatric Surgery

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