title: A decade analysis of trends and outcomes of bariatric surgery in Medicare beneficiaries.
abstract: BACKGROUND
  In 2006, the Centers for Medicare and Medicaid Services issued a National Coverage Determination (NCD), which mandates that bariatric procedures be performed only at accredited centers. The aim of this study was to analyze outcomes of Medicare beneficiaries who underwent bariatric surgery before (2001 through 2005) vs after (2006 through 2010) implementation of the NCD.
  
  
  METHODS
  The Nationwide Inpatient Sample database was used to analyze data on patients who underwent bariatric surgery between 2001 and 2010. Main outcomes measures were demographics, length of stay, risk-adjusted inpatient morbidity and mortality, and cost.
  
  
  RESULTS
  There were 775,040 patients who underwent bariatric surgery, with 16% of the patients Medicare beneficiaries. There was an overall trend for improved in-hospital mortality during the decade (0.35% in 2001 to 0.10% in 2010). Medicare patients who underwent bariatric surgery had higher rates of comorbidities and a higher rate of in-hospital mortality than non-Medicare patients. After the NCD, there was a significant reduction of the in-hospital mortality (0.56% vs 0.23%; p < 0.01) and serious morbidity (9.92% vs 6.98%; p < 0.01) for Medicare patients and a similar reduction of the in-hospital mortality (0.18% vs 0.08%; p < 0.01) and serious morbidity (6.84% vs 5.08%; p < 0.01) for non-Medicare patients. Compared with patients who underwent stapling bariatric procedures at accredited centers, patients at nonaccredited centers had higher risk-adjusted in-hospital mortality (odds ratio = 3.53; 95% CI, 1.01-6.52) and serious morbidity (odds ratio = 1.18; 95% CI, 1.07-1.30). After the NCD, use of bariatric surgery within Medicare beneficiaries increased by 71%.
  
  
  CONCLUSIONS
  Outcomes of bariatric surgery in Medicare beneficiaries have improved substantially since the 2006 NCD. Facility accreditation appears to be a contributing factor to the observed improvement in outcomes.
authors: Department of Surgery, University of California, Irvine, Irvine, CA.
authors: Monica T
authors: MT
authors: Young
authors: Department of Surgery, University of California, Irvine, Irvine, CA.
authors: Mehraneh D
authors: MD
authors: Jafari
authors: Department of Surgery, University of California, Irvine, Irvine, CA.
authors: Alana
authors: A
authors: Gebhart
authors: Department of Statistics, University of California, Irvine, Irvine, CA.
authors: Michael J
authors: MJ
authors: Phelan
authors: Department of Surgery, University of California, Irvine, Irvine, CA. Electronic address: ninhn@uci.edu.
authors: Ninh T
authors: NT
authors: Nguyen
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States