Health Expenditures After Bariatric Surgery: A Retrospective Cohort Study

Objective: To compare expenditures between surgical and matched nonsurgical patients in a retrospective cohort study.

Background: Bariatric surgery leads to substantial improvements in weight and weight-related conditions, but prior literature on postsurgical health expenditures is equivocal.

Methods: In a retrospective study, total outpatient, inpatient, and medication expenditures 3 years before and 5.5 years after surgery were compared between 22,698 bariatric surgery [n = 7127 Roux-en-Y gastric bypass (RYGB), 15,571 sleeve gastrectomy (SG)] patients from 2012 to 2019 and 66,769 matched nonsurgical patients, using generalized estimating equations. We also compared expenditures between patients receiving the 2 leading surgical procedures in weighted analyses.

Results: Surgical and nonsurgical cohorts were well matched, 80% to 81% females, with mean body mass index of 44 and mean age of 47 (RYGB) and 44 (SG) years. Estimated total expenditures were similar between surgical and nonsurgical groups 3 years before surgery ($27 difference, 95% CI: -42, 102), increased 6 months before surgery for surgical patients, and decreased below preperiod levels for both groups after 3 to 5.5 years to become similar (difference at 5.5 years = -$61, 95% CI: -166, 52). Long-term outpatient expenditures were similar between groups. Surgical patients' lower long-term medication expenditures ($314 lower at 5.5 years, 95% CI: -419, -208) were offset by a higher risk of hospitalization. Total expenditures were similar between patients undergoing RYGB and SG 3.5 to 5.5 years after surgery.

Conclusions: Bariatric surgery translated into lower medication expenditures than matched controls, but not lower overall long-term expenditures. Expenditure trends appear similar for the two leading bariatric operations.