title: BEFORE-AND-AFTER STUDY: DOES BARIATRIC SURGERY REDUCE HEALTHCARE UTILIZATION AND RELATED COSTS AMONG OPERATED PATIENTS?
abstract: BACKGROUND
  Healthcare use and costs are about 81% higher for morbidly obese individuals compared to non-obese persons, and 47% higher compared to the non-morbidly obese population. The benefits of bariatric surgery for health are well established, but its mid-term impact on healthcare use and costs remains controversial.
  
  
  METHODS
  This study examines the trends in healthcare use and costs in a Brazilian cohort during a 4-year period before and after surgery. Healthcare use and direct costs related to inpatients and outpatients were retrieved from a healthcare insurance company database from which all cohort members were selected.
  
  
  RESULTS
  Between 2004 and 2010, 4,006 individuals underwent bariatric surgery. Most patients were female (80%) with a mean age of 36.2 years and a mean body mass index of 42.8 kg/m2. Elevated blood pressure was present in 38% of cases and diabetes was found in 12.5% of subjects. Hospital admissions increased consistently after surgery, even after excluding hospitalizations for esthetic surgery and pregnancy-related care. The most prevalent conditions in this group were gastrointestinal diseases. Emergency department visits increased after bariatric procedures, in particular for genitourinary and hematologic problems. Adjusted costs were higher after surgery as assessed during a 4-year follow-up period.
  
  
  CONCLUSIONS
  Results indicate that costs and hospital admissions after bariatric surgery increase following this procedure, even when elective interventions are excluded. Healthcare providers and policy makers need to be aware that a decrease in obesity-related diseases following bariatric surgery does not reduce healthcare use and costs.
authors.affiliation: Unimed BH,Health Technology Assessment Group - GATS;Faculdade de Medicina da Universidade Federal de Minas Geraissilvanakelles@gmail.com.
authors.forename: Silvana Marcia
authors.initials: SM
authors.lastname: Bruschi Kelles
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais,Centro de Pósgraduação.
authors.forename: Carla Jorge
authors.initials: CJ
authors.lastname: Machado
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais,Centro de Pósgraduação.
authors.forename: Sandhi Maria
authors.initials: SM
authors.lastname: Barreto
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000191:economics*; D001938:Brazil; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics*
keywords: Bariatric surgery; Cost analysis; Follow-up studies; Healthcare services evaluation; Morbid obesity