TRENTON – The number of people undergoing bariatric surgery for weight reduction has risen nearly ten-fold in New Jersey, while mortality rates in recent years have remained very low, according to a report released today by the Department of Health and Senior Services.

However, complications such as bleeding, infection, nutritional deficiencies and other conditions are a significant problem for patients.  In the first six months after surgery, 2.1 percent of patients spent between 15 and 138 days in the hospital being treated for complications.

These are among the findings of the Report and Recommendations of the Bariatric Work Group.  DHSS appointed the advisory panel in August 2004 to examine issues related to bariatric surgery, which is used to treat severely obese patients when other approaches have failed.

New Jersey is one of only a few states to conduct such an in-depth examination of bariatric surgery.  It was prompted by the rapid growth of surgery volumes, the lack of readily available data, and concerns about several well-publicized reports of individual patients suffering serious complications or death.

“Last year, 4,000 people underwent this major surgery in New Jersey alone.  This is dramatic evidence that obesity is a very serious public health problem in our society,” said Health and Senior Services Commissioner Fred M. Jacobs, M.D., J.D.

“Preventing overweight, particularly in children, is one of New Jersey’s top public health priorities,” the Commissioner added. “Our Obesity Prevention Task Force is now developing an action plan to support overweight and obesity prevention efforts statewide.” 

To treat patients, bariatric surgeons use procedures that either restrict the amount of food the stomach can hold, prevent complete food absorption in the intestine, or combine the two approaches.  In 2003, there were 108 bariatric surgeons operating in 36 New Jersey hospitals.

          According to the report released today, the number of bariatric surgeries in New Jersey grew from 473 in 1998 to 4,448 in 2003 – an increase of 840 percent.  Volume then declined slightly in 2004 to 4,018.  The drop may be related to hospital or surgeon decisions to stop performing the surgery due to increasing costs of malpractice insurance, or to growing use of health insurance policy limits on coverage, the report suggests.

Mortality rates were low in the two years examined.  In 2001, 11 patients died in a New Jersey hospital within 30 days of surgery, or 0.56 percent.  In 2003, seven died in a New Jersey hospital, for a mortality rate of 0.16 percent.  In both years, deaths occurred among patients considered at high or very high risk of mortality due to co-existing risk factors such as presence of other diseases.

          The quality of bariatric surgery overall appears to have improved in recent years, the report noted.  The rate at which patients must be readmitted to the hospital within a month of surgery has dropped from 2.3 percent in 2001 to 1.26 percent in 2003.  This suggests patients are experiencing fewer serious complications that require in-hospital care.

          The report did find that low-volume surgeons – those performing fewer than 20 cases a year -- had the highest patient mortality rates in 2003.  However, the small number of deaths makes it difficult to draw clear conclusions for this data.

          Although the work group did not recommend mandating separate licensing of bariatric surgery programs, it did recommend that hospitals performing this surgery do so as part of a comprehensive program.

Such a program would perform at least 125 surgeries a year, with each surgeon having a lifetime experience of at least 125 procedures.  It would also commit to ongoing staff education and training; offer support groups and long-term follow-up of patients; provide a physician medical director for bariatric surgery; and use standardized pre- and post-operative care, among other elements of a comprehensive program.

“People considering bariatric surgery, and their families, should carefully review this excellent report,” Dr. Jacobs said.  “In it, the experts strongly encourage people to weigh the risks and benefits of this surgery with their physician, and to carefully evaluate possible surgeons and hospitals.”  The report also includes advice and a list of questions to ask when choosing a surgeon and hospital.

The 21-member Bariatric Work Group is made up of bariatric surgeons; insurers; consumer advocates; representatives of hospital, medical, managed care and quality improvement organizations; and representatives of the Department of Banking and Insurance and the State Health Benefits Plan.

The Work Group was unable to reach a consensus on insurance coverage for bariatric surgery and other obesity treatments.  One concern of insurers has been the extraordinarily high cost of caring for the patients with the most severe complications.  The Work Group report did confirm that 0.7 percent of patients were hospitalized from 30 to 138 days after having the surgery.

          As the Work Group has advised, the DHSS will continue monitoring bariatric surgery by analyzing statewide hospital discharge data.

          The report is available on the DHSS web site at www.state.nj.us/health/hcsa/documents/bariatricsurgeryrpt.pdf.

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Note: See below for additional data highlights from the report.

 

Additional Report Highlights

• In 2003, 79 percent of bariatric surgery patients were female.  Eighty-six percent of patients were between 30 and 64 years of age.
• An estimated 85 percent had private insurance.  Just over six percent were covered by Medicare and 3 percent by Medicaid. The rest were self-pay and charity care.
• Among hospitals, there were no consistent links between the volume of surgery and patient death rates, except that none of the deaths in 2003 occurred in hospitals with fewer than 50 bariatric surgeries.
• Rates of hospital readmission up to 30 days following surgery were lowest for hospitals handling fewer than 10 or more than 500 cases.
• Just over half of surgeons performed fewer than 10 surgeries in 2003.  Six of the 108 surgeons handled 160 or more cases each.
• The average hospital stay for bariatric surgery was 3.8 days.
• Hospital revenues for bariatric surgery were estimated at $52 million in 2003.  Surgeon revenue data were not available.