In-hospital outcomes of weight-loss surgery, also known as "bariatric" surgery, vary widely from one institution to another, and it appears that hospitals that perform the most procedures have the lowest complication rates, according to the First Annual HealthGrades Bariatric Surgery Trends in American Hospitals Study.
HealthGrades, located in Golden, Colorado, rates physicians, hospitals, and nursing homes, and makes this information available on their web site. The company’s healthcare ratings are used by consumers, hospitals, employers and their health plans, liability insurers, and physicians.
In what they call "the first study of its kind," the company used hospital discharge data between 2002 through 2004 to assess in-hospital outcomes of bariatric surgeries. Most of the procedures were gastric bypass or key-hole (laparoscopic) procedures.
The number of bariatric surgeries increased by 34 percent from 2002 to 2004 in the 17 states included in the study. While bariatric surgery is considered the most effective treatment for morbid obesity, it is also associated with significant risk. In this study, roughly 10 percent of patients experienced an in-hospital complication and two patients for every 1000 procedures will die.
Included in their study were 86,520 bariatric procedures performed in 398 hospitals. Excluded were 270 hospitals in which fewer than 30 bariatric surgeries were performed during the study period and if fewer than five surgeries were performed in 2004.
Half of all the surgeries were performed in four states: New York, Florida, Texas and Pennsylvania. Only 644 of patients paid for the surgery themselves in 2002, but the number rose to 1028 by 2004.
According to their risk-adjusted ratings, 17.8 percent of hospitals were classified as "best" performers and given a 5-star rating; 62.1 percent were rated as "as expected" performers with a 3-star rating; and 20.1 percent were rated as "poor performers" and given a 1-star rating.
During the trial period the 5-star hospitals performed 388 surgeries, 3-stars performed 155, and the 1-star hospitals completed 195 surgeries.
The most common serious complications were respiratory, bleeding, and cardiac complications. The risk-adjusted in-hospital complication rate was 5 percent in the 5-star hospitals, versus 15 percent in the 1-star hospitals.
