Past Trend Tracker Features:
Growth in Bariatric Surgery Focuses on Changes in Technique
Considerable attention has been paid to the rapid increase in bariatric surgeries between 1998 and 2002. During this time, the number of bariatric surgeries increased 400 percent, resulting in approximately 85,000 inpatient surgeries in 2002.
Recent studies by Thomson Healthcare show evidence of an increase in the overall volume of bariatric surgery procedures between 2004 and 2006. This growth has been driven by a rise in outpatient surgeries, while inpatient surgeries have remained flat or declined slightly. In addition, analysis indicates that during this same period, a rapid switch to the use of laparoscopic techniques has occurred in both inpatient and outpatient settings.
Growth in Outpatient Procedures
Research also indicates considerable growth in outpatient bariatric surgery procedures between 2004 and 2006. Almost a 50 percent increase in the number of bariatric surgery procedures occurred in the outpatient setting during this two-year period. Estimates suggest that inpatient bariatric surgeries are trending flat to slightly declining, with a decrease of approximately 2 percent between 2004 and 2006. Simultaneously, there has been a rapid increase of nearly 100 percent in laparoscopic outpatient bariatric procedures in the same period, resulting in a two-year increase of 6 percent in total bariatric surgeries performed in the inpatient and outpatient settings.
(Source: Thomson Healthcare Outpatient View Database)
Changes in Technique
Underlying the top-line trends for inpatient bariatric surgeries are significant changes in technique. A comparison of multiple bariatric procedures performed in the inpatient setting indicates an increase in procedures performed laparoscopically. In particular, open procedures, such as high gastric bypass, have been rapidly replaced by procedures that may be done laparoscopically on the inpatient side. As illustrated below, data show a significant decrease in volume – almost 95 percent – in high gastric bypass surgeries between the fourth quarter of 2002 and the second quarter of 2006. In contrast, the estimated procedure volume for laparoscopic gastroenterostomy increased approximately 5 percent between the fourth quarter of 2004 and the second quarter of 2006. Although the trend shows an increase in the number of laparoscopic procedures performed, a specific code for this procedure did not exist until the fourth quarter of 2004, and these procedures may still have been coded as open gastroenterostomy.
(Source: Thomson Healthcare Outpatient View Database)
A similar trend is seen in bariatric surgeries performed in both inpatient and outpatient settings. Analysis from Thomson Healthcare shows what appears to be a rapid shift from open roux-en-y procedures to the laparoscopic equivalent between 2004 and 2006. More than 94,000 open roux-en-y procedures were performed in 2004, while only an estimated 862 of this type of procedure was performed laparoscopically during the same year. Conversely, in 2006 less than 25,000 open roux-en-y procedures were performed, but significantly more of these procedures – approximately 112,400 - were performed laparoscopically in 2006.
(Source: Thomson Healthcare Outpatient View Database)
This apparent shift from open procedures to laparoscopic techniques is partially due to the fact that current procedural terminology (CPT) did not have a code for the laparoscopic form of this procedure until 2005. Although a healthcare common procedure coding system (HCPCS) ‘S’ code existed in 2004, this code may not have been widely used.
Data for this research was provided by Outpatient View from Thomson Healthcare. Outpatient View details the total annual volume for diagnosis and procedures by outpatient setting. Volumes are detailed by region, age, gender, site of service, and payers for the most recent year. The tool includes three years of data for 6,000 procedure codes and more than 8,000 diagnosis codes, and provides a five-year forecast.
