June 28, 2011 (San Diego) -- In people with diabetes, gastric banding is associated with fewer complications and lower costs over the long run than gastric bypass, the most commonly performed surgery for obesity in the U.S., researchers say.
But by four years later, heath care use and costs increased for patients who underwent bypass surgery, while continuing to decline among those who got banding, says researcher Jason Lebowitz, a PharmD candidate at the University of Southern California in Los Angeles.
Weight Loss Surgery: Weighing Pros and Cons
Experts say the research shows why it’s important for people considering weight loss surgery to understand the trade-offs.
Other studies have shown that bypass surgery appears to help patients lose more weight and may treat diabetes more effectively than banding, says Philip Schauer, MD,professor of surgery at the Cleveland Clinic Lerner College of Medicine. He was not involved with the new work.
Bypass surgery also appears to work well over the long run, he tells WebMD. In a recent study, 89% of people with type 2 diabetes who underwent gastric bypass surgery went into remission and 57% were still in remission after five years.
Bypass may offer more dramatic results because the procedure reroutes digestion, bypassing a portion of the small intestine, he says.
Banding does tend to be safer, at least in the short term: About 1% to 2% of patients have short-term complications, compared to 5% of bypass patients, Schauer says. However, the weight loss from banding procedures is more modest, he says.
"In general, if diabetes is pretty severe, and a patient is on a number of medications, he will need a more powerful procedure such as bypass," Schauer says. "But we’re still trying to understand which procedure works better for which patient. We don't have the right balance defined.”
Bypass Weight Loss Surgery: Higher Costs
Lebowitz and colleagues hypothesized that patients' prescription and medical claims might serve as a proxy for how well each procedure performed over the long run.
So they examined prescription claims and other medical records from nearly 2,900 people with type 2 diabetes who underwent weight loss surgery: 2,537 had bypass surgery and 329 had a banding procedure.
In the year before the procedure, people who underwent banding filled an average of 21 prescriptions; by the year afterward, the number had dropped to 16 and by year four, to 13.
In contrast, people who had bypass surgery filled an average of 28 prescriptions in the year before the procedure; by the year afterward, the number had dropped to 19 and by year four, it crept back up to 20.
The average number of hospital visits fell 25% over a four-year period in the banding group, while increasing 15% in the bypass group.
By year four, the banding patients were spending more than $4,000 on their care, while bypass patients spent more than $9,000.
The researchers hypothesize that the higher costs associated with bypass resulted from surgical complications and problems related to poor absorption of nutrients and medications after digestion is rerouted.
The study did not take into account the cost of the surgery itself, which is about $20,000 to $30,000 for either procedure, says Ted Okerson, MD, senior medical director for devices at Allergan Inc., in Irvine, Calif.
Among the study's weakness is that it did not take into account how sick a patient was or how many other conditions he had. For example, some studies have suggested that sicker patients, who would presumably have higher health care costs and need more care, are more likely to have bypass surgery.