Neil Shah1, Jacob A Greenberg2, Glen Leverson3, Luke M Funk4. 1. School of Medicine and Public Health, University of Wisconsin, Madison, WI. 2. School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Surgery, University of Wisconsin, Madison, WI. 3. Department of Surgery, University of Wisconsin, Madison, WI. 4. School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Surgery, University of Wisconsin, Madison, WI. Electronic address: funk@surgery.wisc.edu.
Abstract
BACKGROUND: Drivers of high cost care after bariatric operation have not been well described. We sought to compare 1-year costs between patients who underwent laparoscopic vertical sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass and identify predictors of high cost of care. METHODS: Morbidly obese patients who underwent laparoscopic vertical sleeve gastrectomy (n = 74) or laparoscopic Roux-en-Y gastric bypass (n = 270) at a single institution from 2010-2014 were identified. Patient demographic characteristics, surgeon age, 90-day and 1-year surgical outcomes, and facility cost data were collected. "High cost" patients were defined as those in the top quartile of costs among all patients. Variables hypothesized a priori to be associated with high total costs were included in a bivariate logistic regression model. Those with a P value < .1 were included in a multivariable logistic regression model with "high cost" as the outcome. RESULTS: Laparoscopic vertical sleeve gastrectomy was associated with slightly greater median total 1-year costs ($18,234 vs $17,151; P = .021) and inpatient costs ($15,026 vs $13,990; P = .019). On multivariable analysis, having Medicaid (odds ratio 2.72; 95% confidence interval, 1.47-5.06) compared with private insurance, being readmitted to the hospital (odds ratio 5.48; 95% confidence interval, 2.45-12.26), and experiencing a postoperative complication (odds ratio 4.12; 95% confidence interval, 1.79-9.48) were associated with high-cost care. CONCLUSION: Suboptimal operative outcomes seem to be the primary driver of high overall costs after bariatric operation. Improving postoperative outcomes may result in substantial cost savings.
BACKGROUND: Drivers of high cost care after bariatric operation have not been well described. We sought to compare 1-year costs between patients who underwent laparoscopic vertical sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass and identify predictors of high cost of care. METHODS: Morbidly obesepatients who underwent laparoscopic vertical sleeve gastrectomy (n = 74) or laparoscopic Roux-en-Y gastric bypass (n = 270) at a single institution from 2010-2014 were identified. Patient demographic characteristics, surgeon age, 90-day and 1-year surgical outcomes, and facility cost data were collected. "High cost" patients were defined as those in the top quartile of costs among all patients. Variables hypothesized a priori to be associated with high total costs were included in a bivariate logistic regression model. Those with a P value < .1 were included in a multivariable logistic regression model with "high cost" as the outcome. RESULTS: Laparoscopic vertical sleeve gastrectomy was associated with slightly greater median total 1-year costs ($18,234 vs $17,151; P = .021) and inpatient costs ($15,026 vs $13,990; P = .019). On multivariable analysis, having Medicaid (odds ratio 2.72; 95% confidence interval, 1.47-5.06) compared with private insurance, being readmitted to the hospital (odds ratio 5.48; 95% confidence interval, 2.45-12.26), and experiencing a postoperative complication (odds ratio 4.12; 95% confidence interval, 1.79-9.48) were associated with high-cost care. CONCLUSION: Suboptimal operative outcomes seem to be the primary driver of high overall costs after bariatric operation. Improving postoperative outcomes may result in substantial cost savings.
Authors: Andrew J Vegel; Neil Shah; Anne O Lidor; Jacob A Greenberg; Ying Shan; Xing Wang; Luke M Funk Journal: J Surg Res Date: 2017-06-15 Impact factor: 2.192
Authors: David B Bayne; Manuel Armas-Phan; Sudarshan Srirangapatanam; Justin Ahn; Timothy T Brown; Marshall Stoller; Thomas L Chi Journal: J Endourol Date: 2020-11-06 Impact factor: 2.942
Authors: Jacqueline A Murtha; Dillon C Svoboda; Natalie Liu; Morgan K Johnson; Manasa Venkatesh; Jacob A Greenberg; Anne O Lidor; Luke M Funk Journal: J Laparoendosc Adv Surg Tech A Date: 2021-07-12 Impact factor: 1.766