It's known that surgery itself is expensive, but prior research hinted that people who undergo bariatric procedures may end up needing less, and therefore cheaper, care in the years following.

That evidence was largely based on younger and middle-aged women, the demographic that most often undergoes weight-loss surgery. In the new study, health-related spending dropped off for the mostly middle-aged, male patients after the procedure - but over three years costs never dropped significantly below that of obese men who didn't have surgery.

"It suggests that maybe the economic benefits of bariatric surgery may not be realized as quickly in patients like these," said Matthew Maciejewski, the study's lead author from the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina.

"There are some real health benefits that were realized in these patients, they just don't translate into cost savings in a three-year time," he told Reuters Health.

Maciejewski and his colleagues looked back at healthcare spending for about 1,700 veterans, all with a body mass index of at least 35 - the equivalent of a six-foot person weighing 258 pounds. Most patients were men and about 50 years old, on average. Between 2000 and 2006, half of those people had bariatric surgery at one of 12 different VA centers; the others didn't undergo surgery.

Over the six months leading up to the procedures, healthcare spending was over $30,000 among people preparing for surgery. Most of the additional spending - about $27,000 - was on the surgery itself and associated hospital admission.

In comparison, less than $5,000 was spent during the same period by those not getting the operation. That average six-month healthcare cost held steady for the next three years among veterans who hadn't undergone surgery - and fell to a similar level, but not any lower, among those who'd had a weight-loss procedure, the researchers reported Monday in the journal Archives of Surgery.

"That's an important finding, but you want to balance it with some measure of the benefits," said Thomas Hoerger, a health economist who has studied bariatric surgery at the scientific institute RTI in Research Triangle Park, North Carolina, but wasn't involved in the new study.

Research has suggested that obese people who undergo bariatric surgery and shed pounds lower their blood pressure and cholesterol and have a decreased risk of heart attack, diabetes and stroke.

Still, "This article suggests that doing bariatric surgery is not a no-brainer," Hoerger told Reuters Health.

"This may slow the movement toward bariatric surgery somewhat. Don't expect that it's going to pay for itself."

Dr. Christine Ren-Fielding, chief of bariatric surgery at NYU Langone Medical Center, said differences between patients may also help explain the findings - for example, if people who chose to get weight-loss surgery were somehow sicker to begin with, doctors would expect them to need more costly care in the coming years.

"Maybe we shouldn't wait until these patients get so sick, or they get so heavy," Ren-Fielding, who didn't take part in the new research, told Reuters Health.

"Maybe earlier intervention would make a difference in financial outcomes."

The data for the new study also came from a period before less-invasive bariatric surgery techniques became popular. Making smaller cuts during surgery means patients can spend less time in the hospital and may have fewer complications - both of which end up saving money.

Maciejewski said older men need to be followed for more time to see if they do ultimately end up needing less-intensive, cheaper healthcare after surgery.

SOURCE: bit.ly/NDi3SZ Archives of Surgery, online July 16, 2012.

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