Clinical science
The incidence of bariatric surgery has plateaued in the U.S.

https://doi.org/10.1016/j.amjsurg.2009.11.007Get rights and content

Abstract

Background

Estimates of the procedure incidence for bariatric surgery have been derived primarily from surveys of bariatric surgeons or from inpatient data sources. New population-representative databases of outpatient surgery are available that enable accurate estimations of bariatric surgery case volumes.

Methods

The 2006 National Hospital Discharge Survey, National Inpatient Sample, and National Survey of Ambulatory Surgery were assessed for bariatric surgery procedures. Data were compared with inpatient data from 1993 to 2007. Procedure costs were estimated.

Results

The incidence of bariatric surgery has plateaued at approximately 113,000 cases per year. Open gastric bypass now constitutes only 3% of all cases but costs $4,800 less than laparoscopic procedures. Laparoscopic gastric banding is performed in 37% of all bariatric surgery cases and costs the same as laparoscopic gastric bypass to perform. Complication rates have fallen from 10.5% in 1993 to 7.6% of all cases in 2006. Bariatric surgery costs the health economy at least $1.5 billion annually.

Conclusions

Despite predictions of continued growth of bariatric surgery, it appears that the annual incidence for these operations has remained stable since 2003. Most operations are performed laparoscopically, but open gastric bypass is substantially less costly than laparoscopic operations. Despite its simplicity, laparoscopic gastric banding costs the same as gastric bypass. There is no cost savings associated with ambulatory bariatric surgery.

Section snippets

NSAS

The 2006 NSAS was obtained from the CDC's Web site (http://www.cdc.gov/nchs/nsas.htm). The NSAS is the only national study of ambulatory surgical care in hospital-based and freestanding ambulatory surgery centers. Data for the NSAS were collected for approximately 52,000 ambulatory surgery cases from a nationally representative sample of hospital-based and freestanding ambulatory surgery centers. Sampled facilities were asked to complete a facility questionnaire and return it by mail. The

Results

Figure 1 demonstrates the changes in bariatric operations as practiced in the United States from 1993 to 2006. These procedures increased in incidence from 8,597 procedures in 1993 to a high of 115,194 in 2004 (Table 1). Inpatient procedures began a steady decline in 2004 that resulted in 91,289 cases performed in 2006. In 2006, 21,710 laparoscopic bands were placed in outpatient facilities, such that there were a total of 112,999 bariatric procedures performed in the United States. The annual

Comments

Bariatric surgery has gained in acceptance and popularity, as evidenced by a substantial increase in the procedure incidence after 2001. Its rapid rise resulted in predictions that procedure volumes would continue to increase, given the very large population that could benefit from bariatric surgery.18, 19, 20, 21, 22, 23 This is especially true considering that nonsurgical treatments for weight loss in the morbidly obese are rarely successful in the long term.24 Expansion of procedure volume

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