Obese more likely to return after surgery
Medically disabled Medicaid patients who are obese and have bariatric surgery are more likely to return to work than those who don't have surgery, according to a new study.1
Obesity is linked to diabetes, hypertension, hyperlipidemia, degenerative arthritis, sleep apnea, and left ventricular hypertrophy, and results in dramatic increases in health care costs, says Richard Thirlby, MD, the study's lead author and a bariatric surgeon at Virginia Mason Medical Center in Seattle.
Researchers studied 38 medically disabled patients receiving Medicaid who had Roux-en-Y gastric bypass performed by a single surgeon between 1997 and 2002. They compared these patients with 16 patients receiving Medicaid who were seen by the same surgeon, but did not undergo surgery.
Employees who had the surgery were more likely to return to work, with 37% working, compared with 6% of the other group. "Our study makes a convincing argument for the role of weight loss surgery in morbidly obese Medicaid patients," says Thirlby.
Return to work was more likely in patients who had resolution of comorbid conditions after surgery, such as sleep apnea, diabetes, hypertension, and severe degenerative joint disease, says Thirlby. "On the other hand, return to work was less likely if the patients had no comorbidities or had too many — the cow is out of the barn' population," he says.
These findings suggest that reversible obesity-related comorbidities may be an appropriate prerequisite for approval of bariatric surgery, says Thirlby.
Productivity increased
"Our study involves a trivial number of employees, compared to the entire American work force," says Thirlby. "What about the millions of morbidly obese people in this country who are working despite their disease?"
There is no question that an employee who undergoes successful weight loss surgery will be more productive at work within six to 12 months, with fewer sick days, he says. "They will be more functional, mobile, and alert," says Thirlby. "I could give you countless examples of patients who report that their careers improved after weight loss surgery."
Obesity surgery provides "quality-adjusted life years" that are well within accepted ranges related to "cost-effective" interventions, notes Thirlby. "The problem as I see it, however, is that it takes about six to 12 months to realize the benefits of increased productivity," he says.
The actual cost of the surgery is at least $20,000, and indirect costs include two to six weeks off work post-surgery, says Thirlby. "It takes up to three years to recoup these expenses with decreased health care costs," he adds. "Given the portability of employees, I suspect that most employers would not be willing to allow two to three years to 'get their money back.'"
It's a "no brainer" that bariatric surgery, when performed with appropriate indications and at medical centers of excellence, will increase the employee's health and productivity, says Thirlby. "However, the present data do not allow us to determine definitively the dollar investment required to achieve this benefit," he says.
Reference
- Wagner AJ, Fabry JM, Thirlby RC. Return to work after gastric bypass in Medicaid-funded morbidly obese patients. Arch Surg 2007;142:935-940.
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