title: Claims to the patient insurance after bariatric surgery in Sweden 2000-2012.
abstract: BACKGROUND
  Since 2000, the annual number of bariatric procedures has increased more than 10-fold in Sweden, and in 2012, 94% of these procedures were primary laparoscopic gastric bypass.
  
  
  METHODS
  We studied claims from the national Patient Insurance (Landstingens Ömsesidiga Försäkringsbolag, LÖF) to evaluate if the number of adverse events (AEs) from a patient perspective had increased unproportionally. All claims related to bariatric surgery from January 2000 to March 2012 were identified by ICD-10 codes and divided into 3 main groups: (1) procedure-related AEs (occurring within 30 days), (2) late AEs, and (3) nonsurgical AEs. Logistic regression was used to study the change in claim rate over time. The setting was a university hospital in Sweden.
  
  
  RESULTS
  In total, 359 claims were included, corresponding to 14 claims per 1,000 bariatric procedures (laparoscopic 59%, open 24%, revision 17%). Numbers correlated with the expansion of bariatric surgery and type of procedure routinely performed. Of the procedure-related claims (74% of all claims), postoperative leaks or bleedings were most common. In this group, patients frequently needed additional surgery (69%) and intensive care (42%). Half of the late AEs (69 in total) were related to abdominal pain or malnutrition, including 5 cases of Wernicke's encephalopathy. In total 2% died. Of 344 settled claims, economical compensation was given to 29%.
  
  
  CONCLUSIONS
  In this cohort of patients with insurance claims after bariatric surgery (1.4% of all procedures), procedure-related AEs were severe, with a large amount of patients requiring reoperation and intensive care. No change in claim rate was seen, in spite of the 10-fold increase of bariatric surgery.
authors.affiliation: Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden. Electronic address: martin.skogar@akademiska.se.
authors.forename: Martin
authors.initials: M
authors.lastname: Skogar
authors.affiliation: Patient Insurance LÖF, Box 17830, SE-118 94, Stockholm, Sweden.
authors.forename: Jon
authors.initials: J
authors.lastname: Ahlberg
authors.affiliation: Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D000768:Anesthesia, General / Q000009:adverse effects; D050110:Bariatric Surgery / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Adverse events; Bariatric surgery; Gastric bypass; Insurance claims; Obesity; Surgery