Clinical outcomes after bariatric surgery

A five-year matched cohort analysis in seven US states

Shari Danielle Bolen, Hsien-Yen Chang, Jonathan Weiner, Thomas M. Richards, Andrew D. Shore, Suzanne M. Goodwin, Roger A Johns, Thomas Magnuson, Jeanne Clark

Research output: Contribution to journalArticle

Abstract

Background: Bariatric surgery is the most effective weight loss treatment, yet few studies have reported on short- and long-term outcomes postsurgery. Methods: Using claims data from seven Blue Cross/Blue Shield health plans serving seven states, we conducted a non-concurrent, matched cohort study. We followed 22,693 persons who underwent bariatric surgery during 2003-2007 and were enrolled at least 6 months before and after surgery. Using logistic regression, we compared serious and less serious adverse clinical outcomes, hospitalizations, planned procedures, and obesity-related co-morbidities between groups for up to 5 years. Results: Relative to controls, surgery patients were more likely to experience a serious [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.8-2.0] or less serious (OR 2.5, CI 2.4-2.7) adverse clinical outcome or hospitalization (OR 1.3, CI 1.3-1.4) at 1 year postsurgery. The risk remained elevated until 4 years postsurgery for serious events and 5 years for less serious outcomes and hospitalizations. Some complication rates were lower for patients undergoing laparoscopic surgery. Planned procedures, such as skin reduction, peaked in postsurgery year 2 but remained elevated through year 5. Surgery patients had a 55% decreased risk of obesity-related co-morbidities, such as type 2 diabetes, in the first year postsurgery, which remained low throughout the study (year 5: OR 0.4, CI 0.4-0.5). Conclusions: While bariatric surgery is associated with a higher risk of adverse clinical outcomes compared to controls, it also substantially decreased obesity-related co-morbidities during the 5-year follow-up.

Original languageEnglish (US)
Pages (from-to)749-763
Number of pages15
JournalObesity Surgery
Volume22
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Bariatric Surgery
Cohort Studies
Odds Ratio
Blue Cross Blue Shield Insurance Plans
Confidence Intervals
Hospitalization
Obesity
Morbidity
Laparoscopy
Type 2 Diabetes Mellitus
Weight Loss
Logistic Models
Skin
Health
Therapeutics

Keywords

  • Bariatric surgery
  • Cohort study
  • Complications
  • Obesity treatment
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Clinical outcomes after bariatric surgery : A five-year matched cohort analysis in seven US states. / Bolen, Shari Danielle; Chang, Hsien-Yen; Weiner, Jonathan; Richards, Thomas M.; Shore, Andrew D.; Goodwin, Suzanne M.; Johns, Roger A; Magnuson, Thomas; Clark, Jeanne.

In: Obesity Surgery, Vol. 22, No. 5, 05.2012, p. 749-763.

Research output: Contribution to journalArticle

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abstract = "Background: Bariatric surgery is the most effective weight loss treatment, yet few studies have reported on short- and long-term outcomes postsurgery. Methods: Using claims data from seven Blue Cross/Blue Shield health plans serving seven states, we conducted a non-concurrent, matched cohort study. We followed 22,693 persons who underwent bariatric surgery during 2003-2007 and were enrolled at least 6 months before and after surgery. Using logistic regression, we compared serious and less serious adverse clinical outcomes, hospitalizations, planned procedures, and obesity-related co-morbidities between groups for up to 5 years. Results: Relative to controls, surgery patients were more likely to experience a serious [odds ratio (OR) 1.9; 95{\%} confidence interval (CI) 1.8-2.0] or less serious (OR 2.5, CI 2.4-2.7) adverse clinical outcome or hospitalization (OR 1.3, CI 1.3-1.4) at 1 year postsurgery. The risk remained elevated until 4 years postsurgery for serious events and 5 years for less serious outcomes and hospitalizations. Some complication rates were lower for patients undergoing laparoscopic surgery. Planned procedures, such as skin reduction, peaked in postsurgery year 2 but remained elevated through year 5. Surgery patients had a 55{\%} decreased risk of obesity-related co-morbidities, such as type 2 diabetes, in the first year postsurgery, which remained low throughout the study (year 5: OR 0.4, CI 0.4-0.5). Conclusions: While bariatric surgery is associated with a higher risk of adverse clinical outcomes compared to controls, it also substantially decreased obesity-related co-morbidities during the 5-year follow-up.",
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