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Clinical Outcomes after Bariatric Surgery: A Five-Year Matched Cohort Analysis in Seven US States

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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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Conflicts of Interest

None for any of the authors.

Funding/Support

This study was funded by unrestricted research grants from Ethicon Endo-Surgery, Inc. (a Johnson & Johnson company); Pfizer, Inc.; and GlaxoSmithKline. In-kind support was provided by the BlueCross BlueShield Association and the seven local Blue Cross Blue Shield plans participating in this project. Dr. Bolen’s salary was supported on the following two grants during part of the time she was working on this project: NIH/NCI 5R25T CA111898-04 and RR KL204990. Grant number RR KL204990 was from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The publication’s contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Role of the Sponsor

The funding and collaborating organizations were kept informed of the study’s progress and shared their expertise on certain aspects of the study. In addition, preliminary findings were shared with them, and they were invited to review the manuscript. However, they did not have any direct role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation or approval of the manuscript.

Additional Contributions

We thank the Blue Cross and Blue Shield plans and the many staff members at these sites who actively contributed to this study by providing data and expert advice regarding use of these data. These organizations included Blue Cross Blue Shield of Tennessee, Highmark Blue Cross Blue Shield (of Pennsylvania), Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of North Carolina Independence Blue Cross (of Pennsylvania), Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Blue Cross and Blue Shield of South Dakota, and Blue Cross Blue Shield of Hawaii.

Author information

Authors and Affiliations

  1. Center for Health Care Research and Policy, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, 2500 MetroHealth Drive, Rammelkamp building R234A, Cleveland, OH, 44109, USA

    Shari Danielle Bolen

  2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Hsien-Yen Chang, Jonathan P. Weiner, Thomas M. Richards, Andrew D. Shore & Suzanne M. Goodwin

  3. Department of Anesthesiology/CCM, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Roger A. Johns

  4. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Thomas H. Magnuson

  5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jeanne M. Clark

  6. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

    Jeanne M. Clark

  7. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jeanne M. Clark

Authors
  1. Shari Danielle Bolen
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  2. Hsien-Yen Chang
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  3. Jonathan P. Weiner
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  4. Thomas M. Richards
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  5. Andrew D. Shore
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  6. Suzanne M. Goodwin
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  7. Roger A. Johns
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  8. Thomas H. Magnuson
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  9. Jeanne M. Clark
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Corresponding author

Correspondence to Shari Danielle Bolen.

Appendix

Appendix

Table 3 Codes used to identify bariatric surgery cases and types of surgery
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Table 4 Description of clinical outcome groupings
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Table 5 Proportion of subjects with serious clinical outcomes by time period for entire bariatric surgery cohort and control group
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Table 6 Proportion of subjects with less serious clinical outcomes by time period for entire bariatric surgery cohort and control group
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Table 7 Proportion of subjects with planned procedures by time period for entire bariatric surgery cohort and control group
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Table 8 Proportion of subjects with obesity-related comorbidity by time period for entire bariatric surgery cohort
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Bolen, S.D., Chang, HY., Weiner, J.P. et al. Clinical Outcomes after Bariatric Surgery: A Five-Year Matched Cohort Analysis in Seven US States. OBES SURG 22, 749–763 (2012). https://doi.org/10.1007/s11695-012-0595-2

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