Abstract
Aims
There is a lack of population studies evaluating the impact of bariatric surgery (BRS) on all-cause inpatient mortality. We sought to determine the impact of prior BRS on all-cause mortality and healthcare utilization in hospitalized patients.
Methods
We analyzed the National Inpatient Sample database from 2007 to 2013. Participants were adult (≥ 18 years) inpatients admitted with a diagnosis of morbid obesity or a history of BRS. Propensity score-matched analyses were performed to compare mortality and healthcare resource utilization (hospital length of stay and cost).
Results
There were 9,044,103 patient admissions with morbid obesity and 1,066,779 with prior BRS. A propensity score-matched cohort analysis demonstrated that prior BRS was associated with decreased mortality (OR = 0.58; 95% CI [0.54, 0.63]), shorter length of stay (0.59 days; P < 0.001), and lower hospital costs ($2152; P < 0.001) compared to morbid obesity. A subgroup of propensity score-matched analysis among patients with high-risk of mortality (leading ten causes of mortality in morbid obesity) revealed a consistently significant reduction in odds of mortality for patients with prior BRS (OR = 0.82; 95% CI [0.72, 0.92]).
Conclusion and Relevance
Hospitalized patients with a history of BRS have lower all-cause mortality and healthcare resource utilization compared to those who are morbidly obese. These observations support the continued application of BRS as an effective and resource-conscious treatment for morbid obesity.
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Funding
This work was funded in part by the Ohio State University College of Medicine Roessler Medical Student Research Scholarship (VR).
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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For this type of study, formal consent is not required.
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The authors declare that they have no conflict of interest.
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Key Points
Question: Does prior bariatric surgery provide significantly improved inpatient outcomes and healthcare resource utilization compared to comparable and matched patients with morbid obesity?Findings: In this propensity score-matched cohort study of nearly 10 million patients, we found that all-cause inpatient mortality among patients with a history of bariatric surgery was nearly one third the mortality rate for patients with morbid obesity; further, prior bariatric surgery was associated with lower healthcare resource utilization.Meaning: The findings of this study are highly relevant for future research studying the long-term health benefits and cost-effectiveness of bariatric surgery. The observations in this study support the continued application of bariatric surgery as an effective and resource-conscious treatment for morbid obesity.
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Krishna, S.G., Rawal, V., Durkin, C. et al. Weight Loss Surgery Reduces Healthcare Resource Utilization and All-Cause Inpatient Mortality in Morbid Obesity: a Propensity-Matched Analysis. OBES SURG 28, 3213–3220 (2018). https://doi.org/10.1007/s11695-018-3345-2
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DOI: https://doi.org/10.1007/s11695-018-3345-2