Trends in Use of Bariatric Surgery, 2003-2008

BACKGROUND: During the past decade, the field of bariatric surgery has changed dramatically. This study was intended to determine trends in the use of bariatric surgery in the United States. Data used were from the Nationwide Inpatient Sample from 2003 through 2008. STUDY DESIGN: We used ICD-9 diagnosis and procedural codes to identify all hospitalizations during which a bariatric procedure was performed for the treatment of morbid obesity between 2003 and 2008. Data were reviewed for patient characteristics, annual number of bariatric procedures, and proportion of laparoscopic cases. US Census data were used to calculate the population-based annual rate of bariatric surgery per 100,000 adults. The number of surgeons performing bariatric surgery was estimated by the number of members in the American Society for Metabolic and Bariatric Surgery. RESULTS: For the period between 2003 and 2008, the number of bariatric operations peaked in 2004 at 135,985 cases and plateaued at 124,838 cases in 2008. The annual rate of bariatric operations peaked at 63.9 procedures per 100,000 adults in 2004 and decreased to 54.2 procedures in 2008. The proportion of laparoscopic bariatric operations increased from 20.1% in 2003 to 90.2% in 2008. The number of bariatric surgeons with membership in the American Society for Metabolic and Bariatric Surgery increased from 931 to 1,819 during the 6 years studied. The in-hospital mortality rate decreased from 0.21% in 2003 to 0.10% in 2008. CONCLUSIONS: In the United States, the number of bariatric operations peaked in 2004 and plateaued thereafter. Use of the laparoscopic approach to bariatric surgery has increased to >90% of bariatric operations. In-hospital mortality continually decreased throughout the 6-year period. (J Am Coll Surg 2011;213:261-266. (C) 2011 by the American College of Surgeons)