Getting more than what you pay for? Managing complications of bariatric tourism at an academic center near the US-Mexico border.

BACKGROUND

Potential barriers exist for patients who desire bariatric surgery. Medical tourism, defined as international travel for the purpose of seeking medical care, has emerged as a popular alternative. Despite attempts at care standardization, substantial variation remains regarding institutional accreditation and the availability of appropriate postoperative bariatric care abroad. Management of postoperative complications therefore often falls to providers in the patient's home country. We present our experience with the clinical and financial implications of bariatric tourism as an academic center located 30 miles from the US-Mexico border.

METHODS

A retrospective review of a prospectively maintained database identified patients who underwent cross-border bariatric surgery and then presented to our institution for management of postoperative complications from 2014 to 2024. Outcomes included type and number of procedural interventions required for complication management, length of stay (LOS), total intensive care unit (ICU) days, emergency department (ED) visits, readmissions, and mortality. Hospital charge and payment data for each patient were obtained, accounting for total LOS, interventions performed, readmissions, and ED visits.

RESULTS

A total of 91 patients were identified. The most common index procedure performed abroad was laparoscopic sleeve gastrectomy (N = 63, 69.2%). Common presenting complications included anastomotic/staple line leak (N = 30, 33.0%) and postoperative abdominal pain/nausea/vomiting (N = 24, 26.4%). In total, 194 procedural interventions were performed for complication management, including 112 upper endoscopies (57.7%) and 21 major surgical procedures (10.8%). 56.0% of patients required hospital admission on initial presentation and 19.8% required ICU admission. Anastomotic/staple line leak generated the highest mean hospital charges per patient ($424,975.89 ± $406,136.65), followed by enterocutaneous fistula ($277,076.50 ± $256,475.24). Overall mortality rate was 3.3% (N = 3).

CONCLUSION

Bariatric tourism can present patients and local healthcare systems with significant clinical and financial challenges. Further studies are warranted to more comprehensively evaluate the implications of this practice.