We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Are we operating too late? Mortality Analysis and Stochastic Simulation of Costs Associated with Bariatric Surgery: Reconsidering the BMI Threshold.
- Authors
Sinha, Ashish; Singh, Preet; Bhat, Suneel
- Abstract
Background: Present guidelines recommend bariatric surgery at BMI ≥40 kg/m or BMI ≥35 kg/m with obesity-related morbidity. Methods: Evidence for cost and mortality/morbidity risk of bariatric surgery and obesity-related diseases was evaluated determining equivalency point of absolute incremental mortality risk by BMI and risks associated with bariatric surgery. A stochastic model was developed evaluating costs related to surgical procedure at a given BMI. Results: Bariatric surgery produces significant lifetime cost savings associated with diabetes, gallstones, hypertension, high cholesterol, colon cancer, heart disease, and stroke in men at BMI 30 kg/m for laparoscopic gastric bypass. For women, laparoscopic gastric bypass saves cost at BMI 32 kg/m and laparoscopic gastric banding at BMI 37 kg/m. In white men, relative to single-year mortality risks by BMI, surgical intervention becomes risk-beneficial at BMI 25 kg/m for laparoscopic gastric banding, BMI 27 kg/m for laparoscopic gastric bypass procedure and open gastric banding, and BMI 37 kg/m for open gastric bypass. Risk benefit for African-American men by procedure occurs at BMI <25 kg/m, BMI 27 kg/m, and BMI 42 kg/m, respectively. In white women, surgical intervention is beneficial at BMI 25.5 kg/m (laparoscopic gastric banding), BMI 28.5 kg/m (laparoscopic gastric bypass procedure), and BMI 45 kg/m (open gastric banding). Risk benefit for black women by procedure occurs at BMI 27.5 kg/m, BMI 33.5 kg/m, and BMI 50+ kg/m, respectively. Conclusion: Risk and cost benefit suggest surgical guidelines should be reconsidered. Threshold for bariatric surgery should be redefined to BMI 35 kg/m or BMI 30 kg/m with comorbidities.
- Subjects
BARIATRIC surgery; COMPUTER simulation; BODY mass index; MEDICAL care costs; OPERATIVE surgery; HEALTH &; race
- Publication
Obesity Surgery, 2016, Vol 26, Issue 1, p219
- ISSN
0960-8923
- Publication type
Article
- DOI
10.1007/s11695-015-1934-x