Obese Californians increasingly are turning to surgery to lose weight, and many of them wind up in a Fresno hospital that leads the state in performing the procedures, according to a report released Wednesday.

The central San Joaquin Valley's high obesity rates contribute to the full hospital beds. But the Fresno area also has a reputation for weight-loss surgery.

"We have patients coming from all over the world," said Cynthia Cervantes, chief nursing officer at Fresno Heart & Surgical Hospital.

Of 94 California hospitals where bariatric surgeries were performed in 2009, Fresno Heart & Surgical had the most – 878, more than five times the state average of 153.

Only Scripps Memorial Hospital in La Jolla came close at 834 surgeries, according to "Trends in Bariatric Surgery in California Hospitals, 2005-2009," a report by the Office of Statewide Health Planning and Development.

Statewide, more than 14,500 weight-loss surgeries were performed in 2009, a 6.8% increase from 2005. State researchers said nearly a quarter of Californians are obese and the growing obesity epidemic likely led more people to seek surgical help after they developed health problems that are weight-related, such as diabetes and high blood pressure.

There's no shortage of Valley residents who are obese – Kings County had the state's highest obesity rate in 2009 at 43.3% and Tulare County was second-highest with 38.6% – but health providers say the region's girth isn't responsible for the entire patient load.

Fresno Heart & Surgical and Clovis Community Medical Centers are both accredited as Centers of Excellence for bariatric surgery by national surgical associations.

Patients come to Fresno Heart & Surgical to see Dr. Kelvin Higa, Cervantes said. Higa heads the hospital's bariatric program and is president of the California chapter of the American Society of Bariatric and Metabolic Surgery. The doctor is well known for his surgical techniques and trains surgeons nationally and internationally, Cervantes said.

Higa said Fresno Heart & Surgical's 878 surgeries in 2009 is not a blip: "It's what we do year after year."

The bariatric team doesn't advertise or promote itself, Higa said. Primary-care doctors refer patients, he said.

At Clovis Community Medical Center, advertisements are attracting some patients, but the reputation of Dr. Edward Felix – a longtime bariatric surgeon – also brings patients in. Clovis Community had 392 weight-loss surgeries in 2009, ranking it among the top 10 hospitals for bariatric procedures in the state.

Felix and Higa began their weight-loss surgery careers about the same time here some 20 years ago. Higa was at Clovis Community until about 2007, when he moved to Fresno Heart & Surgical. Both doctors specialize in laparoscopic weight-loss surgery. The less-invasive procedures have mostly replaced operations that require larger incisions.

Felix said more people are having weight-loss surgery because studies show it extends life expectancy.

"If you stay morbidly obese you're decreasing your life-span statistically," he said.

The surgeries also have become more popular as they've become safer – laparoscopic surgeries typically have lower death rates than surgeries requiring larger incisions.

The state report said deaths within 30 days are rare – 1.5 per 1,000 surgeries, or about 20 per year. But hospital readmission within 30 days following surgery was more common, averaging 6.4%. That compares to an average readmission rate of 2.6% for almost all other inpatient procedures.

About 13% of patients experienced complications following bariatric surgery, the report said. The report did not break out complications or readmissions by hospital because it lacked data on patient risk factors such as age, poverty and overall health.

"We were actually fairly comforted by knowing the mortality rate is quite low," said Joseph Parker, a manager at the statewide health planning agency. But the rate of surgical complications was a concern, he said.

In addition, Parker said, "These are only inpatient complications, we have not tracked complications that occurred later and resulted in subsequent readmissions."

Felix said some complications are inherent in the surgery and the rates are not out of line. Patients have to weigh risks against benefits, he said. "If you look at the complications of staying obese at the level of our patients, it's kind of a no-brainer," he said.

Felix and Higa said the question shouldn't be why so many weight-loss surgeries are performed here – but why there are not more.

"We are operating on less than 1% of [medically] eligible patients," Higa said.

But many who could benefit from the surgery either don't have health insurance to pay for it or their insurance companies make it difficult to have the procedure, the doctors said.