Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population

Project Summary Title and Description

Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population
We conducted a technology assessment to summarize and appraise the current evidence regarding the effectiveness and safety of bariatric surgery in the Medicare-eligible population.
Authors of Report
Methodology description
We searched six bibliographic databases and the reference lists of published clinical practice guidelines, relevant narrative and systematic reviews, and scientific information packages from manufacturers and other stakeholders on the outcomes and prediction models of different bariatric procedures studied in the Medicare-eligible population.
Data was entered into this project prospectively, i.e. entering data into SRDR concurrent with the data abstraction task. The Technology Assessment report is available here:
Funding Source

Key Questions

1. KQ 1: What are the theorized mechanisms of action of bariatric procedures on weight loss and type 2 diabetes in the Medicare population?
2. KQ 2: In studies that are applicable to the Medicare population and enroll patients who have undergone bariatric therapy, what are a) the characteristics and indications of patients receiving bariatric therapy including descriptives of age, BMI, and comorbid conditions b) the characteristics of the interventions, including the bariatric procedures themselves as well as pre- and/or postsurgical surgical work-ups (e.g., psychiatric evaluations, behavioral and nutritional counseling) c) the outcomes that have been measured, including peri-operative (i.e., 90 days or less after bariatric surgery), short-term (2 years or less from surgery), mid-term (more than 2 but 5 or less years), and long-term (more than 5 years after surgery) outcomes?
3. KQ3: a) In Medicare-eligible patients, what are the effects of different bariatric therapies (contrasted between them or vs. nonbariatric therapies) on weight outcomes (including failure to achieve at least minimal weight loss)? b) What patient- (KQ2a) and intervention- (KQ2b) level characteristics modify the effect of bariatric therapies on weight outcomes (including failure to achieve at least minimal weight loss)? c) In Medicare-eligible patients who have undergone bariatric therapy, what is the frequency and the predictors of failing to achieve at least minimal weight loss? d) In Medicare eligible patients who do not achieve weight loss after primary bariatric treatment, what is the effect of revisional bariatric therapies (contrasted between them or vs. nonbariatric therapies) on weight outcomes?
4. KQ4: a) In Medicare-eligible patients, what is the comparative effectiveness of different bariatric therapies (contrasted between them or vs. nonbariatric interventions) with respect to the non-weight-loss outcomes in KQ2c and what is the comparative safety of these therapies? b) What patient- (KQ2a) and intervention- (KQ2b) level characteristics modify the effects of the bariatric therapies on the outcomes other than weight loss in KQ2c?
5. KQ5: a) In Medicare-eligible patients who have undergone bariatric therapy, what is the association between weight outcomes and eligible short- and long-term outcomes (other than weight outcomes)? b) In Medicare-eligible patients, what proportion of the bariatric treatment effect on eligible short- and long-term outcomes (other than weight outcomes) is accounted for by changes in weight outcomes?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Bariatric surgery in patients with reduced kidney function: an analysis of short-term outcomes.2015
Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes.2015
Bariatric surgery does not improve outcomes in patients undergoing primary total knee arthroplasty.2015
Comparative effectiveness of 3 bariatric surgery procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and sleeve gastrectomy.2016
Bariatric surgery in Medicare patients: greater risks but substantial benefits.2009
Bariatric Surgery in Patients with Dialysis-Dependent Renal Failure.2015
Assessment of warfarin dosing requirements after bariatric surgery in patients requiring long-term warfarin therapy.2013
The use, safety and cost of bariatric surgery before and after Medicare's national coverage decision.
Survival and changes in comorbidities after bariatric surgery.2008
Advanced age as an independent predictor of perioperative risk after laparoscopic sleeve gastrectomy (LSG).2015
Greater short-term weight loss in women 20-45 versus 55-65 years of age following bariatric surgery.2013
Early morbidity and mortality of laparoscopic sleeve gastrectomy and gastric bypass in the elderly: a NSQIP analysis.2014
Return to work after gastric bypass in Medicaid-funded morbidly obese patients.
Bariatric surgery in patients older than 65 years is safe and effective.2005
Obesity, type 2 diabetes mellitus, and other comorbidities: a prospective cohort study of laparoscopic sleeve gastrectomy vs medical treatment.2012
Morbidity Rates and Weight Loss After Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding in Patients Older Than 60 Years old: Which Procedure to Choose?2016
Association of Patient Age at Gastric Bypass Surgery With Long-term All-Cause and Cause-Specific Mortality.2016
Outcomes of bariatric surgery in the elderly.2006
Comparative effectiveness of bariatric surgery and nonsurgical therapy in adults with type 2 diabetes mellitus and body mass index <35 kg/m2.2011
Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence.2010
Lingering Risk: Bariatric Surgery Before Total Knee Arthroplasty.2016
Outcomes of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Patients Older than 60.2015
Increase of bone resorption and the parathyroid hormone in postmenopausal women in the long-term after Roux-en-Y gastric bypass.2009
Bariatric surgery is associated with a reduced risk of mortality in morbidly obese patients with a history of major cardiovascular events.2012
Safety analysis of primary bariatric surgery in patients on chronic dialysis.2016
Impact of bariatric surgery on quality of life, functional capacity, and symptoms in patients with heart failure.2013
Comparison of weight loss outcomes 1 year after sleeve gastrectomy and Roux-en-Y gastric bypass in patients aged above 50 years.2016
Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.2015
Benefits and risks of bariatric surgery in patients aged more than 60 years.2014
Laparoscopic bariatric surgery can be safe for treatment of morbid obesity in patients older than 60 years.2006
A comparison of outcomes of bariatric surgery in patient greater than 70 with 18 month of follow up.2016
Bariatric surgery in the elderly: 2009-2013.
Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures.2005
Laparoscopic sleeve gastrectomy in the South Pacific. Retrospective evaluation of 510 patients in a single institution.2016
Surgical weight loss >65 years old: is it worth the risk?2010
Bariatric surgery outcomes in the elderly: an ACS NSQIP study.2012
Bariatric surgery in old age: a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence.2015
Impaired weight loss in laparoscopic adjustable gastric banding patients over 50 years of age: diabetes mellitus as an independent risk factor.2016
The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery.2015
Is bariatric surgery safe in the elderly population?2017
Laparoscopic gastric bypass in patients 60 years and older: early postoperative morbidity and resolution of comorbidities.2009
Physical function and health related quality of life before and 18 months after bariatric surgery2017
Outcomes of bariatric surgery in patients >70 years old.-- Not Found --
Laparoscopic mini-gastric bypass in patients age 60 and older.2016
Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York.2016
Sleeve gastrectomy in older obese patients.2013
Laparoscopic gastric banding in over 60s.2011
Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients.-- Not Found --
Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004.2007
Super-Obesity in the Elderly: Is Bariatric Surgery Justified?2015
Laparoscopic gastric bypass beyond age 60.2004
Age impact on weight loss and glycolipid profile after laparoscopic sleeve gastrectomy: experience with 308 consecutive patients.
Laparoscopic Roux-En-Y gastric bypass is a safe and effective operation for the treatment of morbid obesity in patients older than 55 years.2004
Effects of bariatric surgery in older patients.2004
Outcomes of laparoscopic sleeve gastrectomy in patients older than 60 years.2014
Bariatric surgery and diabetes: Implications of type 1 versus insulin-requiring type 2.2015
Biliopancreatic Diversion with Duodenal Switch in the Elderly: Long-Term Results of a Matched-Control Study.
Safety and efficacy of laparoscopic adjustable gastric banding in patients aged seventy and older.-- Not Found --
Safety and outcomes of laparoscopic gastric bypass surgery in patients 60 years of age and older.-- Not Found --
Avoidance of complications in older patients and Medicare recipients undergoing gastric bypass.2007
Outcomes among elderly bariatric patients at a high-volume center.-- Not Found --
Results and complications after Swedish adjustable gastric banding in older patients.2008
Addressing morbid obesity as a barrier to renal transplantation with laparoscopic sleeve gastrectomy.2015
Differences in outcomes of laparoscopic gastric bypass.2011
Readmissions Following Gastric Bypass Surgery.2016
Safety and efficacy of laparoscopic adjustable gastric banding in the elderly.2008
Laparoscopic Roux-en-Y gastric bypass is effective and safe in over 55-year-old patients: a comparative analysis.2014
Laparoscopic sleeve gastrectomy in patients over 60 years: impact of age on weight loss and co-morbidity improvement.2015
Male patients above age 60 have as good outcomes as male patients 50-59 years old at 1-year follow-up after bariatric surgery.2009
Sleeve gastrectomy in the elderly: a safe and effective procedure with minimal morbidity and mortality.2013
Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation.2016
Comparing quality of life outcomes between Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass using the RAND36 questionnaire.2017
Laparoscopic gastric bypass surgery: a safe and effective operation for the ≥60s?2016
Midterm effects of bariatric surgery in patients with insulin-treated type 2 diabetes.2016
Risk of Heart Failure in Obese Patients With and Without Bariatric Surgery in Sweden-A Registry-Based Study.2017
Variation in Weight and Obesity Comorbidities After Open Roux-en-Y Gastric Bypass by Health Insurance: Medicaid vs Medicare vs Private vs Self-Pay in 4225 Bariatric Outcomes Longitudinal Database Patients.2017
Benefits of bariatric surgery before elective total joint arthroplasty: is there a role for weight loss optimization?2017
Sleeve gastrectomy in the elderly: A case-control study with long-term follow-up of 3 years.2017
Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults.2017
Metabolic surgery in patients over 60 years old: short- and long-term results2016
Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study.2017
Estimated GFR Before and After Bariatric Surgery in CKD.2017

Downloadable Data Content

  • XLSX Project Data