Four-Year Hospital Resource Utilization After Bariatric Surgery: Comparison with Clinical and Surgical Controls

Rates and reasons for emergency department presentations of patients wait-listed for public bariatric surgery in Tasmania, Australia

BACKGROUND

Demand for bariatric surgery in the public hospital setting in Australia is high with prolonged wait-list times. Policy-makers need to consider the consequences of expanding public bariatric surgery including on emergency department (ED) presentations.

AIMS

To describe and evaluate public ED presentation rates and reasons for presenting in a cohort of patients wait-listed for public surgery.

METHODS

All Tasmanians placed on the public wait-list for primary bariatric surgery in 2008-2013 were identified using administrative datasets along with their ED presentations in 2000-2014. The presentations were assigned to one of three periods: before wait-list placement, whilst on the wait-list, and after wait-list removal for publicly-funded surgery or drop-out. A negative binomial mixed-effects regression model was used to derive ED presentation incidence rate ratios (IRR) to compare observation periods and patient groups.

RESULTS

652 wait-listed patients had 5149 public ED presentations. 178 patients had publicly-funded bariatric surgery - all as laparoscopically adjustable gastric banding (LAGB). Overall, ED presentation rates did not change significantly post-surgery compared with the waiting period (IRR 1.19, 95%CI 0.90-1.56). Presentation rates significantly increased for digestive system (IRR 2.02, 95%CI 1.19-3.45) and psychiatric diseases (IRR 4.85, 95%CI 1.06-22.26) after surgery. The likelihood of being admitted from the ED significantly increased after surgery (31.7%-38.9%, p<0.05).

CONCLUSION

ED presentations were common for patients wait-listed for public bariatric surgery and rates did not decrease over an average of three years post-LAGB. The likelihood of being admitted to the hospital from the ED increased after surgery.

Economic evaluation of bariatric surgery to combat morbid obesity: a study from the West of Scotland

INTRODUCTION

The increasing prevalence of obesity has now become a global concern. Forecasts of its health and financial ramifications have prompted the need for effective interventions. Bariatric surgery is an effective measure to control obesity and its related comorbidities, but its high up-front costs have raised questions about its cost-effectiveness. In this study we evaluated the health care-related direct cost savings after bariatric surgery.

METHODS

Data were prospectively obtained from patients who underwent bariatric surgery between May 2008 and April 2011, and a review was performed. These patients' annual cost of regular medications, hospital admissions and outpatient clinic visits were compared with the postoperative costs of these services. Data were collected from January 2005 to April 2012.

RESULTS

The analysis included 88 patients, 17 of whom were men and 71 were women. The procedures included 36 laparoscopic adjustable gastric banding, 33 sleeve gastrectomies and 19 Roux-en-Y gastric bypasses. All procedures were laparoscopic. Data were collected from patients during a median preoperative period of 60 months (range, 42-75 months) and a median postoperative period of 24 months (range, 12-45 moths). Annual savings were £11 452 on medications, £16 420 on hospital admissions and £2532 on outpatient clinic visits. Total annual savings were £30 404.

CONCLUSION

Given the rising prevalence of morbid obesity, bariatric surgery is a cost-effective treatment for morbid obesity and should be made available to morbidly obese patients.

Sexual hormones and erectile function more than 6 years after bariatric surgery

BACKGROUND

The long-term effect of bariatric intervention on androgenic hormones and erectile function is not well known. In a prospective comparative study, the profile of sexual function was ascertained. The setting was a large public academic hospital.

METHODS

A total of 51 patients were included in the present study. Of these, 23 were in the bariatric surgery cohort (with 6-14 yr of follow-up), 14 were obese controls, and 14 were lean controls, aged 30-65 years. The groups were matched for age and, in the case of obese controls, the current body mass index. The measurements included orchidometry, an assessment of gynecomastia, the International Index of Erectile Function, the Aging Males Symptoms questionnaire, the measurement of 12 hormones, and general biochemical measurements.

RESULTS

Bariatric patients lost substantial weight (59.8 ± 12.1 versus 35.1 ± 7.7 kg/m(2)), albeit residual obesity was the rule, with varying degrees of sleep apnea, hypertension, and glucose/lipid aberrations. The total and free testosterone and sex hormone-binding globulin levels were greater in the gastric bypass patients than in the obese controls and comparable to those of lean individuals. The International Index of Erectile Function final score revealed no differences; however, the domains of erectile dysfunction (P = .015) and overall satisfaction (P = .028) were better than those in the obese controls, although still lower than those in the lean group. The correlation between the body mass index and the International Index of Erectile Function score in the entire population (n = 51) was negative, as expected, with, however, low r and r(2) indexes (.354 and .125, respectively).

CONCLUSION

The findings are consistent with long-term normalization of androgenic hormones but less than complete normalization of erectile function. This seeming contradiction might be explained by the remaining or relapsing obesity or its co-morbidities.