Objective: Treatment of chronic diseases such as obesity by resource intensive therapy such as Laparoscopic Roux-en-Y Gastric Bypass surgery (LRYGB) is associated with early increases in healthcare costs. With the increasing frequency of LRYGB being performed and the rising cost of health care, preoperative optimization may reduce resource utilization and these early costs. We sought to investigate the independent contributions of modifiable and non-modifiable factors to resource utilization in LRYGB.
Methods: American College of Surgeons’ 2007 National Surgical Quality Improvement Program (NSQIP) database was used. 6322 patients of this multicenter (183 academic and private US hospitals participating), prospective database who underwent LRYGB were studied. Resource variables were operative time (OT), hospital length of stay (LOS), as well as occurrence of 17 postoperative complications comprising of wound infection, organ space infection, wound dehiscence, pneumonia, reintubation, on ventilator > 48 hours, pulmonary embolus, deep venous thrombosis, renal insufficiency, renal failure, stroke, coma, cardiac arrest, myocardial infarction, bleeding, sepsis and return to operating room. Bivariable and multivariable linear and logistic regressions were performed.
Results: Mean age was 44.2±11.2 years. Mean BMI was 49.3±8.6. Male:female ratio was 1212:5126. Mean LOS was 2.59±2.88 days. Mean OT was 139.3±55.9 minutes. Being a male increased OT by 7.8 minutes (p<0.001) and decreased LOS by 0.2 days (p=0.04). Increase in age by 1 year increased OT by 0.24 minutes and LOS by 0.01 days (p=0.0006). African Americans had longer OT by 5.66 minutes (p=0.007) while presence of CVA increased OT by 22.4 minutes (p=0.04). There was no significant effect on LOS with both. A rise in BMI by 1 increased OT by 0.33 minutes (p<0.001) without a significant effect on LOS. Decremental functional status added 1.93 days to LOS (p<0.0001) and 15.7 minutes to the OT (p=0.08). Diabetic patients had longer LOS by 0.19 days (p=0.03), and COPD patients by 1.46 days (p<0.0001). There was no significant effect on OT. Smoking, alcohol use, congestive heart failure and angina had no significant effect on OT or LOS. History of MI had no effect on LOS, but increased OT by 92 minutes (p=0.09). Multivariate logistic regression to determine factors which independently pose a risk for postoperative complications showed only African American race (OR – 0.72 95% CI-0.52-0.99) and hypertension (OR – 0.71 95% CI- 0.54-0.93) as statistically significant.
Conclusions: We have identified modifiable determinants of resource utilization in laparoscopic gastric bypass surgery including functional status, CVA, obesity, diabetes, hypertension and COPD, of which each is associated with significant healthcare expenditure. The impact of these determinants on resource utilization in LRYGB can be reduced through education and prevention programs. Non-modifiable determinants of resource utilization including age, sex and race can be used to influence patient and procedure selection.
Session: Podium Presentation
Program Number: S059