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July 2006, Vol 96, No. 7 | American Journal of Public Health 1187-1189
© 2006 American Public Health Association
DOI: 10.2105/AJPH.2004.060129

RESEARCH AND PRACTICE

Gastric Bypass Surgery in the United States, 1998–2002

Tonya M. Smoot, PhD, Ping Xu, MSPH, Peter Hilsenrath, PhD, Nancy C. Kuppersmith, MS and Karan P. Singh, PhD

Tonya M. Smoot, Ping Xu, and Nancy C. Kuppersmith are with the University of Louisville, Louisville, Ky. Peter Hilsenrath and Karan P. Singh are with the University of North Texas Health Sciences Center, Fort Worth.

Correspondence: Requests for reprints should be sent to Tonya M. Smoot, PhD, PO Box 548, Mansfield, TX 76063 (e-mail: smootmcmillan{at}aol.com).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 

We assessed the prevalence of gastric bypass surgeries in the United States on the basis of data from the 1998 to 2002 National Hospital Discharge Survey. Between 1998 and 2002, rates (per 100 000 adults) increased significantly (P<.001): from 7.0 to 38.6. This observed increase in the rate of gastric bypass surgery for the treatment of obesity may be attributed in part to improvements in surgical technique, improved patient outcomes, and increased popularity of this procedure.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
The prevalence of obesity in the US population continues to increase, making obesity a major public health concern.1–4 Bariatric surgery has become a popular method of treating obesity, with gastric bypass surgery emerging as the most widely used of these surgical procedures.5–8

We used the National Hospital Discharge Survey, an annual probability sample of discharged patients from nonfederal, short-stay (average length of stay of fewer than 30 days), noninstitutional hospitals in the United States, to examine annual rates and patient characteristics associated with the gastric bypass procedure from 1998 to 2002. A detailed description of the sample design and data collection method of the National Hospital Discharge Survey has been published in detail elsewhere.9


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
Diagnoses and procedures in the National Hospital Discharge Survey were coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM ).10 Gastric bypass was defined as the presence of an ICD-9-CM procedure code of 44.31 or 44.39, corresponding to the Roux-en-Y procedure, and all other bypass procedures. Obese and morbidly obese patients were identified by the presence of accompanying ICD-9-CM diagnostic codes 278.01, 278.00, 278.0, 278.1, or 278.8. Patients with diagnosis codes corresponding to abdominal neoplasm and other malignant neoplasm were excluded from analysis (codes 150.0 through 159.9, inclusive).

Diagnoses corresponding to selected independent predictors in the Charlson Comorbidity Index were used to measure the burden of comorbid disease in our sample. The specific diagnoses summarized are those for myocardial infarction, congestive heart failure, peripheral vascular disease, dementia, cerebrovascular disease, chronic pulmonary disease, connective tissue disease, ulcer disease, mild liver disease, hemiplegia, moderate to severe renal disease, diabetes, moderate to severe liver disease, and metastatic solid tumor.11,12

The estimated annual number of gastric bypass procedures was derived from the sampling weights provided with the National Hospital Discharge Survey. Annual population rates were calculated by using the adjusted adult (aged 18 years or older) civilian population of the United States in each corresponding survey year as the denominator.9 Rate estimates were not based on the population of overweight adults and were not adjusted for the number of adults who may have previously had a gastric bypass surgery.

Trends in annual bypass procedure rates were assessed with the {chi}2 test for trend.13 Overall differences for the period under study between female and male discharged patients, geographic region, and payer type were analyzed with the {chi}2 test and the Cochran–Mantel–Haenszel {chi}2 test. Non-parametric rank sum tests were used to test for trends or differences for patient age. Statistical significance was declared when the computed P value was less than .05. All statistical tests were 2-sided, and all analyses were performed with SAS for Windows software (SAS Institute Inc, Cary, NC).


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Annual rates and selected characteristics of patients undergoing gastric bypass surgery are summarized in Table 1Go. The annual rate of gastric bypass surgeries increased significantly from 7.0 to 38.6 per 100 000 adults between 1998 and 2002 (P < .001). Overall, an estimated 180546 gastric bypass surgeries were performed; the estimated annual number of gastric bypass surgeries increased sharply from 14089 in 1998 to 82 636 in 2002. The Roux-en-Y procedure—the "gold standard" of bariatric surgical procedures—was the most commonly performed type of gastric bypass procedure, accounting for slightly more than 70% of the procedures performed annually.5,14–16


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  		TABLE 1— Gastric Bypass Surgery in the United States, 1998–2002
 
Comorbidities accompanying gastric bypass surgery are summarized in Table 2Go. Overall, the most common comorbid conditions associated with the surgery were diabetes and chronic pulmonary disease.


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  		TABLE 2— Summary of Comorbid Conditions (%) Accompanying Gastric Bypass Surgeries in the United States, 1998–2002
 
Women received a consistently greater percentage of bypass surgeries annually (about 80%). Overall, the estimated total number of bypass surgeries performed on women (150 249 procedures) was nearly 5 times the number performed on men (30297 procedures).


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
In this nationally representative sample of adult patients undergoing gastric bypass surgery for the treatment of obesity, we observed a nearly 6-fold increase in surgery rates. Previous national and statewide population-based studies6,17–19 reported similar findings. One plausible explanation for the marked increase in rates beginning in 2000 is the 2001 US Food and Drug Administration approval of the laparoscopic-adjustable gastric banding surgical technique.14,20 Although this surgery is more costly and time intensive, patient recovery times are shorter, and the surgery itself is less invasive.21–24

Obesity is accompanied by a host of chronic and life-threatening comorbid conditions.1–4,25–28 Thus, the maintained and significant weight loss resulting from gastric bypass surgery may prove, in the long term, to be cost-effective and health-preserving. Hence the observed upward trend in the number of gastric bypass surgeries is not surprising.


   Acknowledgments
 
The authors acknowledge Elizabeth M. Smigielski of the University of Louisville Kornhauser Health Sciences Library for her expert assistance with the literature search process in support of this research.

Human Participant Protection
No institutional review board approval was required for this study. This study involved only a secondary data analysis of data extracted from a public use database.


   Footnotes
 
Peer Reviewed

Contributors
T.M. Smoot originated the study and was responsible for statistical and methodological guidance, interpretation of data, and preparation of the brief. P. Xu conducted all statistical analyses, summarized results, interpreted data, and was responsible for initial preparation of the brief. All of the authors contributed to the writing, reviewing, and editing of the brief.

Accepted for publication September 2, 2005.


   References
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The continuing epidemic of obesity in the United States. JAMA. 2000;284:1650–1651.[Free Full Text]

2. Healthy People 2010: Understanding and Improving Health. Washington, DC: US Dept of Health and Human Services; 2001.

3. Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Ga: Centers for Disease Control and Prevention; 2002.

4. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–1727.[Abstract/Free Full Text]

5. Brolin RE. Bariatric surgery and long term control of morbid obesity. JAMA. 2002;288:2793–2796.[Free Full Text]

6. Pope GD, Birkmeyer JD, Finlayson SR. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002;6:855–861.[CrossRef][ISI][Medline]

7. Livingston EH. Obesity and its surgical management. Am J Surg. 2002;184:103–113.[CrossRef][ISI][Medline]

8. Mitka M. Surgery for obesity: demand soars amid scientific, ethical questions. JAMA. 2003;289:1761–1762.[Free Full Text]

9. Dennison C, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 1. 2000;No. 39:1–42.

10. World Health Organization. International Classification of Disease, Ninth Revision, Clinical Modification. Geneva, Switzerland: World Health Organization; 1980.

11. Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993; 46:1075–1079.[CrossRef][ISI][Medline]

12. D’Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996;49:1429–1433.[CrossRef][ISI][Medline]

13. Agresti A. Categorical Data Analysis. 2nd ed. Hoboken, NJ: John Wiley & Sons, Inc; 2002.

14. Fobi MA, Lee H, Holness R, DeGaulle C. Gastric bypass operation for obesity. World J Surg. 1998;22: 925–935.[CrossRef][ISI][Medline]

15. Nguyen NT, Lopez JA, O’Brien P, Provost D. Gastric bypass and adjustable-band surgery for obesity. Contemp Surg. 2003;59:403–410.

16. Barrow CJ. Roux-en-Y gastric bypass for morbid obesity. AORN J. 2002;76:590, 593–604.[CrossRef][Medline]

17. Zizza CA, Herring AH, Stevens J, Carey TS. Bariatric surgeries in North Carolina, 1990–2001: a gender comparison. Obes Res. 2003;11:1519–1525.[ISI][Medline]

18. Erickson JL, Remington PL, Peppard PE. Trends in bariatric surgery for morbid obesity in Wisconsin. WMJ. 2004;103:32–37.[Medline]

19. Buechner JS. Gastric bypass surgery for obesity. Med Health R I. 2003;86:81–82.[Medline]

20. Ferraro DR. Laparoscopic adjustable gastric banding for morbid obesity (review). AORN J. 2003;77:923–940.[Medline]

21. Nehoda H, Weiss H, Labeck B, et al. Results and complications after adjustable gastric banding in a series of 250 patients. Am J Surg. 2001;181:12–15.[CrossRef][ISI][Medline]

22. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–291.[CrossRef][ISI][Medline]

23. Patterson EJ, Urbach DR, Swanstrom LL. A comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model. J Am Coll Surg. 2003;196:379–384.[CrossRef][ISI][Medline]

24. Smith SC, Edwards CB, Goodman GN, Halversen RC, Simper SC. Open vs. laparoscopic Roux-en-Y gastric bypass; comparison of operative morbidity and mortality. Obes Surg. 2004;14:73–76.[CrossRef][ISI][Medline]

25. MacDonald KG. Overview of the epidemiology of obesity and the early history of procedures to remedy morbid obesity. Arch Surg. 2003;138:357–360.[Free Full Text]

26. Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991–1998. JAMA. 1999; 282:1519–1522.[Abstract/Free Full Text]

27. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes and obesity-related health factors, 2001. JAMA. 2003;289:76–79.[Abstract/Free Full Text]

28. Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med. 1993;119(7 pt 2):655–660.[Abstract/Free Full Text]




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This Article
Right arrow Abstract Freely available
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AJPH.2004.060129v1
96/7/1187    most recent
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Right arrow Articles by Smoot, T. M.
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Right arrow Articles by Smoot, T. M.
Right arrow Articles by Singh, K. P.
Related Collections
Right arrow Obesity, Overweight, Underweight
Right arrow Other Chronic Disease
Right arrow Surveys

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