Bookkeeping for Laparoscopic Nissen Fundoplication: Nationwide Sample Analysis

Kenneth W Bueltmann, MD, Marek Rudnicki, MD, PhD

Advocate Illinois Masonic Medical Center, Chicago, Illinois

INTRODUCTION: Nissen Fundoplication is used for the treatment of gastroesophageal reflux disorder (GERD) when medical efforts have failed. Laparoscopic Nissen Fundoplication (LNF) is offered to patients with GERD more often than open Nissen Fundoplication (ONF). It might be expected that this trend is dictated not only by well established benefits of minimally invasive surgery but also by decreased costs and potential increased revenue margin.

METHODS AND PROCEDURES: The Nationwide Inpatient Sample (NIS) from the Health Cost Utilization Project was analyzed using HCUPnet and NIS datasets and SAS 9.2 for the years 2005 through 2010. Queries were made for ONF and LNF (ICD-9 44.66, 44.67). Overall number of surgeries, demographics, LOS, and mortality was calculated. Data for charges, cost and profit were available for 2005 and 2009 at time of submission. The NIS weighting algorithm was used for National estimates. The NIS Z-score calculator was utilized for all p values.

RESULTS: There was a 28% increase in number of LNF between 2005 and 2010. At the same time, number of patients operated with open approach dropped by 7%. Average age of the patient rose to 57.2 and to 58.6 (7% and 4% respectively, p<.001) for LNF and ONF. Female predominance increased to 68% for LNF (increase by 5%, p<.001) and remained at 65% for ONF. Average length of stay remained unchanged in the LNF (3 days) and decreased from 7.4 to 6.7 days (-10%, p<.05) for ONF. The hospital mortality increased to 3/1000 surgeries for LNF (63% increase vs. 2005, p<0.05) and remained constant at 10/1000 surgeries for ONF. Mean charges for LNF procedures increased from $27,381+/- 508 to $38,154+/-611 (39%, p<0.001) and $51,536+/-1,843 to $65,901+/-2757 (28%, p<0.001) LNF and ONF, respectively. Weighted group average cost was $11,282+/-188 for LNF in 2005 and increased to $13,892+/-213 in 2009 (23%, p<0.001). For the same period cost of ONF was $19,078+/-612 and $22,093+/-835 (16%, p<0.005). Group average profit for LNF increased from $16,099+/-343 to $24,262+/-421 for LNF (51%, p<0.05) and from $32,458+/-1,310 to $43,808+/-1,962 for ONF between 2005 and 2009 (35%, p<0.001) respectively. Weighted group average cost increased by 23.13 % for LNF (p<0.001) and 15.8% for ONF (p<0.001). During the same period, group average profit increased by 50.7% for LNF (p<0.001) and 34.97% for ONF (p<0.001). Average potential profit margin increased by 10.8% for LNF (p<0.001) and 11.7% for ONF (p<0.001).

CONCLUSION: There is an increased trend in utilization of LNF vs. ONF. These changes were accompanied by higher cost of procedures and simultaneous growth in charges. Although cost of LNF is lower than ONF, LNF procedure has become more profitable since 2005, yet it still demonstrates a slightly lower profit margin when compared to ONF.

Session: Poster Presentation

Program Number: P538

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