Procedure incidence and in-hospital complication rates of bariatric surgery in the United States

BACKGROUND: Complication rates for bariatric surgery have been reported primarily from academic centers with specialized programs. The rates may not reflect those occurring in the community. METHODS: The National Hospital Discharge Survey (NHDS) database maintained by the Center for Disease Control (CDC) was queried to determine the national incidence and complication rate for bariatric surgery as performed in the United States. RESULTS: The number of bariatric procedures rapidly increased from 6,868 in 1996 to 45,473 in 2001, with most of the increase attributable to a very large rise in the annual number of Roux-en-Y gastric bypasses performed. The in-hospital complication rate was 9.6% and 8.6% of patients has a length of stay exceeding 7 days. Cholecystectomies were performed concurrently in 28% of cases and were not associated with increases in complication rates or longer hospital stays. For those undergoing surgery, the most common preoperative comorbid conditions were hypertension (34%), arthritis (27%), GERD (22%), sleep apnea (22%), and diabetes (18%). CONCLUSIONS: The rate at which bariatric procedures are being performed is rapidly increasing, resulting in the need to establish practice standards. In-house complication rates derived from a cross section of US practices compare favorably with those reported from specialized centers. Based on these nationally representative data, the expected in-house clinically significant complication rate for bariatric operations is approximately 10%. As that is the average complication rate observed nationally, it serves as the benchmark to which bariatric surgery programs can compare themselves.