Hans F Fuchs, MD1, Ryan C Broderick, MD1, Cristina R Harnsberger, MD1, David C Chang, PhD2, Bryan J Sandler, MD3, Santiago Horgan, MD1, Garth R Jacobsen, MD1. 1Center for the Future of Surgery, University of California, San Diego, 2Massachusetts General Hospital, Department of Surgery, Codman Center, Harvard Medical School, 3Center for the Future of Surgery, University of California, San Diego; VA San Diego Healthcare Syst
Bariatric tourism is a recognized phenomenon, as many patients chose to undergo bariatric surgery abroad. Less expenses drive this rising market, rather than lower complication rates. The aim of this study is to determine the variation of charges, mortality, and length of stay (LOS) in bariatric surgery on a national level.
A retrospective analysis of the Nationwide Inpatient Sample (NIS) database was performed. Obese patients who underwent open or laparoscopic gastric bypass or sleeve gastrectomy were identified by ICD-9 codes and then subdivided by state. Patients <18 years were excluded. Outcomes included mortality, length of stay (LOS), and total charges. Univariate, bivariate, and multivariate analyses were performed. Results were adjusted for age, race, gender, Charlson comorbidity index, state, patient income level, and insurance status.
From 1998-2011, 209,106 patients underwent inpatient bariatric surgery (91% gastric bypass, 9% sleeve gastrectomy). Mean hospital charges were $43,399, mean LOS 3.0 days, and mean in-hospital mortality rate 0.22 %. Comparing to California, adjusted total hospital charges were significantly higher only in Nebraska (+$26,273; P<0.05). Nearly all other states had lower charges, for example, bariatric surgery in New York was $38,317 less (P<0.05). However, in-hospital mortality was higher in nearly all other states compared to California. Significant differences in LOS were found in New York (+0.26d), Florida (+0.32d), and Nevada (-1.54d).
Patients undergoing bariatric surgery in the U.S. are subject to highly variable hospital charges, with differences in mortality and LOS across states. There are trade-offs between expenses and outcomes within the U.S., and thus, caution should be exercised when engaging in bariatric tourism for monetary reasons.