Scientists have identified that obesity can contribute to a marked increase in length of hospital stays and, as a result, cost of hospital visits for elective surgical procedures not directly related to their obesity. Another study has found that in some cases, obesity-related surgeries can be completed as outpatient procedures, reducing the associated costs. In addition, research shows that services for bariatric patients may be significantly inadequate in the U.S.
"Currently, a major focus in medicine is on preventive measures to work against the prevalence of obesity, but in the interim, it is important to have facilities and therapies available to save lives and treat the host of conditions that result from excess body weight," said Barbara Bass, M.D., of the University of Maryland School of Medicine.
Obesity Increases Cost and Length of Stay Among Patients Undergoing Elective Surgical Procedures (Abstract 107662*)
In addition to costs incurred through its association with more than 40 different medical disorders, obesity increases length of stay and thus costs of hospital visits for common elective surgical procedures, according to researchers from the Massachusetts General Hospital Weight Center.
Obesity [measured by elevated body mass index (BMI)] impacted length of stay and cost of care for a number of procedures, including abdominal hysterectomy (AH, n=456), vaginal hysterectomy (VH, n=111) and vertebral disc excision (VDE, n=348), but had no effect on the costs of knee or hip replacement surgery or prostatectomy. For AH, each unit increase in BMI was associated with a $58.00 increase in costs during the hospital stay. For patients undergoing VDE, total costs were nearly $1,000.00 more for a patient with severe obesity than for one with a healthy body weight (BMI 20-25). Most importantly, these cost differences were over and above the costs conferred by the major obesity-related medical problems (diabetes, heart disease and stroke).
Between 1999 and 2002, researchers measured height and weight of all patients electively admitted to the institution, and primary procedures, total costs and length of stay were determined from the administrative database. Overall, 33 percent of the electively-admitted patients were overweight (BMI 25-30) and 36 percent were obese (BMI >30). Severe obesity (BMI >40) was more common in the admitted patients (8.7%) than in the general population (3.4%).
"Extending our research by analyzing specific causes for these increased costs may lead to improvements in quality and cost of care by providing improved facilities, services, and treatment programs for obese patients," said Alison Hoppin, M.D., lead author of the study.
Adjustable Gastric Banding as an Outpatient Procedure: A Multi-Institutional Experience of 700 Successful Patients (Abstract 160942*) Adjustable gastric banding surgeries, which are becoming increasingly frequent in America's hospitals, may be appropriate as outpatient procedures for certain eligible obese patients, offering a safe and convenient alternative for this population, according to research from the University of Illinois at Chicago.
A total of 700 patients were selected for outpatient adjustable lap band surgery between March 2001 and October 2003. Patients were excluded from outpatient surgery for a BMI greater than 55 in one institution, greater than 70 in the other; cardiac disease; and sleep apnea requiring c-pap (continuous positive airway pressure, one of the most common treatments for severe apnea). Twenty patients selected for the outpatient surgery were diagnosed with post-procedure obstruction of the gastric pouch. All of these patients were admitted to the hospital for IV fluids, and stayed for three to five days until they were able to take liquids. No patient who was discharged the day of surgery was subsequently readmitted in the immediate post-operative period. Length of stay following surgery averaged four hours.
"We feel that for certain patients who can benefit from gastric banding procedures, offering an outpatient option provides them with a safe, effective alternative," said Scott Helton M.D. "Outpatient procedures are less expensive and more efficient for both the patient and the hospital. In addition, this study demonstrates that these patients can be safely operated upon in a surgicenter which further reduces the cost of the procedure."
Laparoscopic Gastric Bypass Results in Decreased Medication Costs Within Six Months (Abstract 100861*)
Undergoing gastric bypass surgery to treat morbid obesity significantly reduces medication costs for related conditions, according to research conducted by scientists at the University of Wisconsin.
The study analyzed the monthly prescription medication costs for 50 laparoscopic gastric bypass patients prior to surgery and six months post-operatively. Patients were on an average of 3.7 prescription medicines pre-op (an average cost of approximately $217.60), compared to 1.7 medications post-op (an average cost of approximately $97.30).
The results were particularly notable in patients suffering from gastroesophageal reflux disease (GERD), diabetes and hyperlipidemia, an elevation of fats such as cholesterol and triglycerides in the blood stream. In the study, the percentage of patients with GERD dropped from 32 to four after surgery, and average monthly prescription medication costs for treating GERD decreased from $110.60 to $19.20. Average monthly prescription costs for treating diabetes shrunk from $64.90 to $2.00, and the same costs for treating hyperlipidemia, at $85.80 per month prior to surgery, disappeared entirely for those patients in the study. "Based on our results, we believe that the overall financial burden to the health care system is likely even more dramatically decreased, both in this short interval and over longer intervals," said Jon Gould, M.D., lead author of the study.
Patients in the study were mostly female (86%) and experienced a mean excess weight loss at six months after surgery of 51 percent. All patients took non-prescription multivitamins, oral B12 and calcium, post-operatively. Retail costs were determined by a query on drugstore.com, an online pharmacy, and generic drugs were selected when appropriate. Costs for diabetic supplies and monitoring were not included in the analysis.
Marked Improvement of Gastroesophageal Reflux Disease (GERD), Hypertension, Diabetes, and Other Obesity-Related Illnesses Following a Gastric Restriction Procedure with an Adjustable Band (Abstract 105717*)
Performing an increasingly common gastric restriction surgery with an adjustable band in obese patients provides significant benefits in weight loss and reduced obesity-related illnesses, most notably in the treatment of gastroesophageal reflux disease (GERD), according to scientists from Park Plaza Hospital in Texas.
Patients' mean body mass index (BMI) decreased from an average of 45.8 kg/m2 to 36.7 kg/m2. In comorbidities, researchers noted that in patients suffering from GERD prior to the surgery, 73 percent of cases (35 pts) were resolved and 15 percent (7 pts) improved. In addition, 64 percent of hyperlipidemia cases (10 pts) prior to surgery were resolved. With regard to hypertensive conditions, 43 percent (17 pts) were resolved as a result of the surgery. A significant reduction in average triglyceride levels, from 158.2 mg/dL to 119.9 mg/dL was noted, although average cholesterol was not reduced. Greater weight loss led to greater reduction in triglycerides. Excessive triglyceride levels may lead to coronary artery disease.
"We know that gastric procedures using the new Lap-Band system can be effective weight loss methods for people suffering from morbid obesity," said Hadar Spivak, M.D., lead author of the study. "Based on this research, we can confirm that these procedures improve the overall health of patients and reduce a number of serious illnesses."
The study, which monitored results of the gastric restriction procedure using an adjustable Lap-Band system, determined whether the minimally-invasive surgery would impact not only weight, but obesity-associated conditions including GERD, hypertension, hyperlipidemia, diabetes, asthma and sleep apnea. A total of 163 patients who underwent the procedure and completed at least 16 months of follow-up were included in the study, and data was collected through office visits and questionnaires.
Obesity-related illness status was assessed by comparing medications prescribed for each condition before surgery and at follow-up (20 months on average). Based on type and doses of medications, a resolved, improved, or not improved scale was created. Lap-Band surgery involves the placement of a band around the stomach, which restricts the amount of food in the stomach and limits food flow to the GI tract.
Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 15-20, 2004 in New Orleans, Louisiana. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.
*Abstract numbers listed above correlate to abstract ID numbers listed on the DDW Web site, www.ddw.org. They do not coincide with program numbers as found in the printed DDW Program Guide.