Top

Surgical Endoscopy

Published in:

01-05-2020 | Obesity

Surgeon presence and utilization of bariatric surgery in the United States

Authors: Sarah E. Billmeier, Rachel B. Atkinson, Gina L. Adrales

Published in: Surgical Endoscopy | Issue 5/2020

Abstract

Background

Bariatric surgery is the most effective long-term treatment for morbid obesity; however, it is under-utilized. This study examines the association between morbid obesity rates, bariatric surgeon presence, and utilization of bariatric surgery in the United States.

Methods

Healthcare Cost and Utilization Project’s 2013 National Inpatient Sample was used to determine the incidence of inpatient bariatric procedures using ICD-9 codes. The Center for Disease Control’s 2013 Behavioral Risk Factor Surveillance System survey was analyzed to determine estimates of bariatric surgery qualified adults, aged 18–70, with BMI ≥ 40 or ≥ 35 with diabetes. The number of bariatric surgeons was determined from four online sources: searches of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program accredited bariatric programs, American Society for Metabolic and Bariatric Surgery membership, and two adjustable gastric band manufacturer “find a surgeon” search tools. Correlations between rates of morbid obesity, bariatric surgeon presence, and incidence of inpatient bariatric surgery were determined.

Results

The defined bariatric surgery eligible population comprised between 3.6% (New England) to 6.8% (East South Central) of the total division population (p < 0.001). Incident rates of bariatric surgery ranged from 0.9% in East South Central to 2.2% in New England (p < 0.001). 2124 bariatric surgeons were identified. The rate of bariatric surgery by division was negatively correlated with division morbid obesity rates (r = − 0.65) and strongly positively correlated with surgeon presence (r = 0.91). After adjusting for demographic differences between divisions, surgeon presence remained highly associated with surgery utilization (p < 0.001).

Conclusions

Rates of bariatric surgery procedures in the U.S. are minimally correlated with rates of morbid obesity and are strongly correlated with the number of available bariatric surgeons. Effective therapy for the morbidly obese may be limited by the lack of qualified surgeons.

Sturm R, Hattori A (2013) Morbid obesity rates continue to rise rapidly in the United States. Int J Obes 37:889–891. https://doi.org/10.1038/ijo.2012.159 CrossRef

Sturm R (2003) Increases in clinically severe obesity in the united states, 1986-2000. Arch Intern Med 163:2146–2148. https://doi.org/10.1001/archinte.163.18.2146 CrossRefPubMed

Flegal KM, Kit BK, Orpana H, Graubard BI (2013) Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309:71–82. https://doi.org/10.1001/jama.2012.113905 CrossRefPubMedPubMedCentral

Haslam DW, James WPT (2005) Obesity. Lancet 366:1197–1209. https://doi.org/10.1016/S0140-6736(05)67483-1 CrossRefPubMed

Cawley J, Meyerhoefer C (2012) The medical care costs of obesity: an instrumental variables approach. J Health Econ 31:219–230. https://doi.org/10.1016/j.jhealeco.2011.10.003 CrossRefPubMed

Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737. https://doi.org/10.1001/jama.292.14.1724 CrossRefPubMed

Maggard-Gibbons M, Maglione M, Livhits M et al (2013) Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA 309:2250–2261. https://doi.org/10.1001/jama.2013.4851 CrossRefPubMed

Sjöström L, Peltonen M, Jacobson P et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65. https://doi.org/10.1001/jama.2011.1914 CrossRefPubMed

Schauer PR, Bhatt DL, Kirwan JP et al (2014) Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med 370:2002–2013. https://doi.org/10.1056/NEJMoa1401329 CrossRefPubMedPubMedCentral

10.

Ikramuddin S, Billington CJ, Lee W-J et al (2015) Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol 3:413–422. https://doi.org/10.1016/S2213-8587(15)00089-3 CrossRefPubMedPubMedCentral

11.

Mingrone G, Panunzi S, De Gaetano A et al (2015) Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 386:964–973. https://doi.org/10.1016/S0140-6736(15)00075-6 CrossRefPubMed

12.

Arterburn DE, Olsen MK, Smith VA et al (2015) Association between bariatric surgery and long-term survival. JAMA 313:62–70. https://doi.org/10.1001/jama.2014.16968 CrossRefPubMed

13.

Sjöström L, Narbro K, Sjöström CD et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752. https://doi.org/10.1056/NEJMoa066254 CrossRefPubMed

14.

English WJ, DeMaria EJ, Brethauer SA et al (2018) American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis 14:259–263. https://doi.org/10.1016/j.soard.2017.12.013 CrossRefPubMed

15.

Nguyen NT, Masoomi H, Magno CP et al (2011) Trends in use of bariatric surgery, 2003–2008. J Am Coll Surg 213:261–266. https://doi.org/10.1016/j.jamcollsurg.2011.04.030 CrossRefPubMed

16.

Nguyen NT, Vu S, Kim E et al (2016) Trends in utilization of bariatric surgery, 2009–2012. Surg Endosc 30:2723–2727. https://doi.org/10.1007/s00464-015-4535-9 CrossRefPubMed

17.

Flum DR, Khan TV, Dellinger EP (2007) Toward the rational and equitable use of bariatric surgery. JAMA 298:1442–1444. https://doi.org/10.1001/jama.298.12.1442 CrossRefPubMed

18.

Poulose BK, Holzman MD, Zhu Y et al (2005) National variations in morbid obesity and bariatric surgery use. J Am Coll Surg 201:77–84. https://doi.org/10.1016/j.jamcollsurg.2005.03.022 CrossRefPubMed

19.

Livingston EH, Ko CY (2004) Socioeconomic characteristics of the population eligible for obesity surgery. Surgery 135:288–296. https://doi.org/10.1016/j.surg.2003.07.008 CrossRefPubMed

20.

Martin M, Beekley A, Kjorstad R, Sebesta J (2010) Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis 6:8–15. https://doi.org/10.1016/j.soard.2009.07.003 CrossRefPubMed

21.

CDC - BRFSS 2013 Survey Data and Documentation. https://www.cdc.gov/brfss/annual_data/annual_2013.html. Accessed 1 Feb 2019

22.

HCUP-US NIS Overview. https://www.hcup-us.ahrq.gov/nisoverview.jsp#about. Accessed 1 Feb 2019

23.

Surgeon Locator| Health Partner for Weight Loss Surgery. https://weightlosssurgery.thehealthpartner.com/surgeon-locator?utm_source=redirects&utm_medium=realize.com&utm_campaign=301_redirects#!/. Accessed 10 July 2017

24.

Find a LAP-BAND^® Specialist | LAP-BAND^® http://www.lapband.com/find-a-specialist. Accessed 10 July 2017

25.

Data By Region - Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org/data/region/. Accessed 1 Feb 2019

26.

Cremieux P-Y, Buchwald H, Shikora SA et al (2008) A study on the economic impact of bariatric surgery. Am J Manag Care 14:589–596PubMed

27.

Glover J (1938) The incidence of tonsillectomy in school children: (Section of Epidemiology and State Medicine). Proc R Soc Med 31:1219–1236PubMedPubMedCentral

28.

Surgical Procedures - Dartmouth Atlas of Health Care. http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=22. Accessed 1 Feb 2019

29.

Fuchs VR (1978) The supply of surgeons and the demand for operations. J Hum Resour 13:35–56. https://doi.org/10.2307/145247 CrossRefPubMed

30.

Fisher ES (2003) The implications of regional variations in medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med 138:288. https://doi.org/10.7326/0003-4819-138-4-200302180-00007 CrossRefPubMed

Title: Surgeon presence and utilization of bariatric surgery in the United States
Authors: Sarah E. Billmeier
Rachel B. Atkinson
Gina L. Adrales
Publication date: 01-05-2020
Publisher: Springer US
Keywords: Obesity
Obesity
Bariatric Surgery
Bariatric Surgery
Care
Published in: Surgical Endoscopy / Issue 5/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07001-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Surgeon presence and utilization of bariatric surgery in the United States

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2020

Prediction of early discharge after gynaecological oncology surgery within ERAS

Post-operative complications and readmissions following outpatient elective Nissen fundoplication

S054: incidence and management of jejunojejunal intussusception after Roux-en-Y gastric bypass: a large case series

Oncological and anorectal functional outcomes of robot-assisted intersphincteric resection in lower rectal cancer, particularly the extent of sphincter resection and sphincter saving

One-stop routing for surgical interventions: a cost-analysis of endoscopic groin repair

An international comparison of the utilisation of and outcomes from minimal access surgery for the treatment of common abdominal surgical emergencies