DOI: 10.1097/MLR.0b013e31824f6d49
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Issn Print: 0025-7079
Publication Date: 2012/05/01
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Excerpt
We read the article by Bleich et al1 describing higher inpatient and overall health care costs after bariatric surgery with great concern. It has serious flaws. First, the failure to differentiate between bariatric operations: extensive literature shows superior remission of type 2 diabetes mellitus (T2DM) after gastric bypass versus gastric banding.2 Forty percent of their patients had a laparoscopic procedure, most often gastric banding, eroding the lower health care costs after the more effective “bariatric surgery.” Furthermore, complications after open bariatric surgery are 10× those for laparoscopic procedures that probably contributes to the higher inpatient costs.3
More serious, the absence of a control group fails to account for the natural history of severe obesity and T2DM, where bariatric operations, especially bypass, have a primary preventive capacity. During a 6 year period many nondiabetic obese patients, mean age 47, develop T2DM, whereas diabetic patients develop complications; both generate much greater expenditures in nonsurgical patients.4 The authors must have access to Blue Cross Blue Shield records for creating propensity-matched controls. Three controlled studies document significant decreases in medical costs in bariatric surgery patients.5–7
Because of the natural lag in accumulating and analyzing data of this nature, the results presented in this paper are largely out of date and of questionable relevance to current practice. Currently >90% of all bariatric procedures are laparoscopic with fewer surgical complications and rehospitalizations (most commonly incisional hernia), in contrast to the 40% in this report, and most diabetics undergo gastric bypass.8 Indeed, the International Diabetes Federation has concluded that bariatric surgery, especially gastric bypass, is indicated for severely obese patients with T2DM.
