CHARACTERISTICS AND TRENDS IN BARIATRIC SURGERY IN THE U.S., 1999-2004, AND A COMPARISON OF SURGICAL PATIENTS TO THOSE ELIGIBLE FOR SURGERY

Severe obesity (BMI >= 40 kg/m2) increases risk for many diseases (e.g., hypertension, diabetes). Bariatric surgery is the treatment with the greatest long-term success for severe obesity, sustaining weight loss and improving health. The number of bariatric surgeries has increased tremendously in recent years, although the percentage of adults eligible for surgery that receive the surgery is very small. Using the National Hospital Discharge Survey (1999-2004), patient, surgical, and hospital characteristics were analyzed over this six year time period. Using the National Health and Nutrition Examination Survey (NHANES), severely obese adults were compared to bariatric surgical patients with respect to age, sex, and health insurance for the years 2003 and 2004. Chi-square tests were used to test for differences in characteristics, and tests for trend were performed to test for temporal trends. Poisson regression was used to model length of hospital stay. From 1999 to 2004, most bariatric surgical patients were 30-49 years old, female, and were expected to pay with private insurance only. The most common comorbidities among bariatric surgical patients were hypertension (45.5%), sleep apnea (25.8%), and diabetes (21.8%). The majority of bariatric surgeries performed were high gastric bypasses. The number of bariatric surgeries increased more than 15-fold from 2000 to 2003. Length of hospital stay decreased from 1999 to 2004. Those who had gastroplasty were more likely to have a shorter hospital stay compared to other procedures.Only about 2.3% of severely obese individuals in the United States received bariatric surgery in 2003-2004. Males, younger and older adults, and those with public insurance were under-represented among bariatric surgical patients in 2003 and 2004. Because obesity is a major public health concern, discrepancies in characteristics of adults who are eligible for bariatric surgery compared to those receiving the surgery need to be addressed. Clinical practices should make sure everyone eligible is aware and well-informed of bariatric surgery. Healthcare policies should eventually allow every candidate the choice of having bariatric surgery, to improve health and reduce healthcare costs