National trends in utilization and outcomes of bariatric surgery

  • T. L. Trus
  • G. D. Pope
  • S. R. G. Finlayson
Original article



Because of the growing interest in surgery to treat morbid obesity, this study examined changes in the utilization and in-hospital outcomes of bariatric surgery in the United States over a 10-year period.


Data were obtained from the Nationwide Inpatient Sample, the largest all-payer discharge database in the United States. International Classification of Disease (ICD-9) codes were used to identify all bariatric procedures performed for adults from 1990 to 2000. Population-based rates of surgery for each year were calculated by applying sampling weights and U.S. Census data. Secular trends in annual rates of surgery, changes in patient characteristics, and in-hospital mortality and complications were analyzed.


From 1990 to 2000, the national annual rate of bariatric surgery increased nearly six fold, from 2.4 to 14.1 per 100,000 adults (p = 0.001). There has been more than a ninefold increase in the use of gastric bypass procedures (1.4 to 13.1 per 100,000; p < 0.001). This represents an increase from 55% of all bariatric procedures in 1990 to 93% of such procedures in 2000 (p < 0.001). The rates of in-hospital mortality were low (0.4% overall), but increased slightly over time (0.2% in 1990 to 0.5% in 2000; p = 0.009). There is no significant difference in adjusted mortality for the past 8 years, but a slight rise did occur over the full 10-year period. The rates for reoperation (1.3%) and pulmonary emboli (0.3%) remained stable. The rates for respiratory failure associated with bariatric surgery declined from 7.7% in 1990 to 4.5% in 2000 (p < 0.001). Over this time, the mean length of hospital stay declined from 6.0 to 4.1 days (p < 0.001).


The annual rate of bariatric surgery in the United States increased nearly six fold between 1990 and 2000, with_little change in in-hospital morbidity and mortality. This appears to be driven largely by the increasing popularity of gastric bypass procedures.


Obesity Surgery Epidemiology Trends 


  1. 1.
    Balsiger, BM, Kennedy, FP, Abu-Lebdeh, HS, Collazo-Clavell, M, Jensen, MD, O’Brien, T, Hensrud, DD, Dinneen, SF, Thompson, GB, Que, FG, Williams, DE, Clark, MM, Grant, JE, Frick, MS, Mueller, RA, Mai, JL, Sarr, MG 2000Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesityMayo Clin Proc75673680PubMedGoogle Scholar
  2. 2.
    Benotti, PN, Bistrain, B, Benotti, JR, Blackburn, G, Forse, RA 1992Heart disease and hypertension in severe obesity: the benefits of weight reductionAm J Clin Nutr55586S590SPubMedGoogle Scholar
  3. 3.
    Benotti, PN, Hollingshead, J, Mascioli, EA, Bothe, A,Jr, Bistrian, BR, Blackburn, GL 1989Gastric restrictive operations for morbid obesityAm J Surg157150155PubMedGoogle Scholar
  4. 4.
    Bray, GA 1985Complications of obesityAnn Intern Med10310521062PubMedGoogle Scholar
  5. 5.
    Brolin, RE, Kenler, HA, Gorman, JH, Cody, RP 1992Long-limb gastric bypass in the super obese: a prospective randomized studyAnn Surg215387395PubMedGoogle Scholar
  6. 6.
    Charuzi, I, Lavie, P, Peiser, J, Peled, R 1992Bariatric surgery in morbidly obese sleep apnea patients: short- and long-term follow-upAm J Clin Nutr55594S596SPubMedGoogle Scholar
  7. 7.
    Charuzi, I, Ovnat, A, Peiser, J, Saltz, H, Weitzman, S, Lavie, P 1985The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndromeSurgery97535538PubMedGoogle Scholar
  8. 8.
    Ellison, LM, Heaney, JA, Birkmeyer, JD 2000The effect of hospital volume on mortality and resource use after radical prostatectomyJ Urol163867869PubMedGoogle Scholar
  9. 9.
    Flegal, KM, Carroll, MD, Kuczmarski, RJ, Johnson, CL 1998Overweight and obesity in the United States: prevalence and trends, 1960-1994Int J Obes223947Google Scholar
  10. 10.
    Flegal, KM, Carroll, MD, Ogden, CL, Johnson, CL 2002Prevalence and trends in obesity among U.S. adults, 1999-2000J Am Med Assoc28817231727Google Scholar
  11. 11.
    Fobi, MA, Lee, H, Holness, R, Cabinda, D 1998Gastric bypass operation for obesityWorld J Surg22925935CrossRefPubMedGoogle Scholar
  12. 12.
    Foley, EF, Benotti, PN, Borlase, BC, Hollingshead, J, Blackburn, GL 1992Impact of gastric restrictive surgery on hypertension in the morbidly obeseAm J Surg163294297PubMedGoogle Scholar
  13. 13.
    Gastrointestinal Surgery for Severe Obesity. NIH Consensus Statement 1991, Mar 25–27; 9: 1-20Google Scholar
  14. 14.
    Gleysteen, JJ 1992Results of surgery: long-term effects on hyperlipidemiaAm J Clin Nutr55591S593SPubMedGoogle Scholar
  15. 15.
    Gleysteen, JJ, Barboriak, JJ 1983Improvement in heart disease risk factors after gastric bypassArch Surg118681684PubMedGoogle Scholar
  16. 16.
    Gleysteen, JJ, Barboriak, JJ, Sasse, EA 1990Sustained coronary risk factor reduction after gastric bypass for morbid obesityAm J Clin Nutr51774778PubMedGoogle Scholar
  17. 17.
    Goldstein, N (1998) Prescribing drugs as a learned intermediary, Physician’s News Digest, Philadelphia, Vol 11, p 7Google Scholar
  18. 18.
    Griffen, WO, Bivins, BA, Bell, RM, Jackson, KA 1981Gastric bypass for morbid obesityWorld J Surg5817822PubMedGoogle Scholar
  19. 19.
    Griffen, WO, Young, VL, Stevenson, CC 1977A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesityAnn Surg186500509PubMedGoogle Scholar
  20. 20.
    Hall, JC, Watts, JM, O’Brien, PE, Dunstan, RE, Walsh, JF, Slavotinek, AH, Elmslie, RG 1990Gastric surgery for morbid obesity. The Adelaide StudyAnn Surg211419427PubMedGoogle Scholar
  21. 21.
    (HCUP) HCaUiP (2002) Nationwide Inpatient Sample (NIS): Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar
  22. 22.
    Howard, L, Malone, M, Michalek, A, Carter, J, Alger, S, Woert, J 1995Gastric bypass and vertical banded gastroplasty: a prospective randomized comparison and 5-year follow-upObes Surg55560CrossRefPubMedGoogle Scholar
  23. 23.
    Hosmer, DW, Lemeshow, S 1989Applied logistic regressionJohn WileyNew YorkGoogle Scholar
  24. 24.
    Jones, KB 2000Experience with the Roux-en-Y gastric bypass, and commentary on current trendsObes Surg10183185CrossRefPubMedGoogle Scholar
  25. 25.
    Kellum, JM, DeMaria, EJ, Sugerman, HJ 1998The surgical treatment of morbid obesityCurr Probl Surg35791858PubMedGoogle Scholar
  26. 26.
    Leffler, E, Gustavsson, S, Karlson, BM 2000Time trends in obesity surgery 1987 through 1996 in Sweden: a population-based studyObes Surg10543548PubMedGoogle Scholar
  27. 27.
    MacDonald, KG, Pories, WJ 1992Roux gastric bypass or vertical banded gastroplastyProb Gen Surg9321331Google Scholar
  28. 28.
    Mason, EE, Maheer, JW, Scott, DH, Rodriguez, EM, Doherty, C 1992Ten years of vertical banded gastroplasty for severe obesityProbl Gene Surg9280289Google Scholar
  29. 29.
    Mokdad, AH, Bowman, BA, Ford, ES,  et al. 2003Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001JAMA2897679CrossRefPubMedGoogle Scholar
  30. 30.
    Mokdad, AH, Bowman, BA, Ford, ES, Vinicor, F, Marks, JS, Koplan, JP 2001The continuing epidemics of obesity and diabetes in the United StatesJAMA28611951200CrossRefPubMedGoogle Scholar
  31. 31.
    Mokdad, AH, Marks, JS, Stroup, DF, Gerberding, JL 2004Actual causes of death in the United States, 2000JAMA29112381245CrossRefPubMedGoogle Scholar
  32. 32.
    Mokdad, AH, Serdula, MK, Dietz, WH, Bowman, BA, Marks, JS, Koplan, JP 1999The spread of the obesity epidemic in the United States, 1991-1998JAMA28215191522CrossRefPubMedGoogle Scholar
  33. 33.
    Mokdad, AH, Serdula, MK, Dietz, WH, Bowman, BA, Marks, JS, Koplan, JP 2000The continuing epidemic of obesity in the United StatesJAMA28416501652PubMedGoogle Scholar
  34. 34.
    Naslund, I 1987Gastric bypass versus gastroplasty: a prospective study of differences in two surgical procedures for morbid obesityActa Chirurg Scand Suppl536160Google Scholar
  35. 35.
    National Task Force on the Prevention and Treatment of Obesity1993Very low calorie dietsJAMA270967974Google Scholar
  36. 36.
    Nguyen, NT, Goldman, C, Rosenquist, CJ, Arango, A, Cole, CJ, Lee, SJ, Wolfe, BM 2001Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costsAnn Surg234279289discussion 289-291CrossRefPubMedGoogle Scholar
  37. 37.
    Perri, MG, Fuller, PR 1995Success and failure in the treatment of obesity: where do we go from here?Med Exerc Nutr Health4255272Google Scholar
  38. 38.
    Pope, GD, Birkmeyer, JD, Finlayson, SRG 2002National trends in utilization and in-hospital outcomes of bariatric surgeryJ Gastrointest Surg6855860PubMedGoogle Scholar
  39. 39.
    Pories, WJ 1991The surgical approach to morbid obesitySabiston, DC eds. Textbook of surgery: the biologic basis of modern surgical practiceWB SaundersPhiladelphia, PA851866Google Scholar
  40. 40.
    Pories, WJ, MacDonald, KG,Jr, Morgan, EJ, Sinha, MK, Dohm, GL, Swanson, MS, Barakat, HA, Khazanie, PG, Leggett-Frazier, N, Long, SD 1992Surgical treatment of obesity and its effect on diabetes: 10-year follow-upAm J Clin Nutr55582S585SPubMedGoogle Scholar
  41. 41.
    Pories, WJ, Swanson, MS, MacDonald, KG, Long, SB, Morris, PG, Brown, BM, Barakat, HA, deRamon, RA, Israel, G, Dolezal, JM 1995Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitusAnn Surg222339350discussion 350-352PubMedGoogle Scholar
  42. 42.
    Romano, PS, Roos, LL, Jollis, JG 1993Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectivesJ Clin Epidemiol4610751079discussion 1081-1090PubMedGoogle Scholar
  43. 43.
    Safer, DJ 1991Diet, behavior modification, and exercise: a review of obesity treatments from a long-term perspectiveSouth Med J8414701474PubMedGoogle Scholar
  44. 44.
    Scopinaro, N, Gianetta, E, Adami, GF, Friedman, D, Traverse, E, Marinari, GM, Cuneo, S, Vitale, B, Ballari, F, Colombini, M, Baschieri, G, Bachi, V 1996Biliopancreatic diversion for obesity at eighteen yearsSurgery119261268PubMedGoogle Scholar
  45. 45.
    Sugerman, HJ, Fairman, RP, Baron, PL, Kwentus, JA 1986Gastric surgery for respiratory insufficiency of obesityChest908186PubMedGoogle Scholar
  46. 46.
    Sugerman, HJ, Fairman, RP, Sood, RK, Engle, K, Wolfe, L, Kellum, JM 1992Long-term effects of gastric surgery for treating respiratory insufficiency of obesityAm J Clin Nutr55597S601SPubMedGoogle Scholar
  47. 47.
    Sugerman, HJ, Kellum, JM, Engle, KM, Wolfe, L, Starkey, JV, Birkenhauer, R, Fletcher, P, Sawyer, MJ 1992Gastric bypass for treating severe obesityAm J Clin Nutr55560S566SPubMedGoogle Scholar
  48. 48.
    Sugerman, HJ, Londrey, GL, Kellum, JM, Wolf, L, Liszka, T, Engle, KM, Birkenhauer, R, Starkey, JV 1989Weight loss with vertical banded gastroplasty and Roux-Y gastric bypass for morbid obesity with selective versus random assignmentAm J Surg15793102PubMedGoogle Scholar
  49. 49.
    Weintraub, M,  et al. 1992Long-term weight control study IV (weeks 156-190): the second double-blind phaseClin Pharmacol Ther51608614PubMedGoogle Scholar
  50. 50.
    Yale, CE 1989Gastric surgery for morbid obesity: complications and long-term weight controlArch Surg124941946PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • T. L. Trus
    • 1
  • G. D. Pope
    • 1
  • S. R. G. Finlayson
    • 1
  1. 1.Department of SurgeryDartmouth-Hitchcock Medical CenterLebanonUSA

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