Kyle L Kleppe, MD, Yiwei Xu, Xing Wang, Jeff Havlena, Luke M Funk, MD, MPH, Jake A Greenberg, MD, EdM, Anne O Lidor, MD, MPH. University of Wisconsin
Background: While clinical outcomes have been reported for antireflux surgery, there is limited data on postoperative outpatient encounters and their associated costs. The aim of this study is to evaluate the utilization of healthcare and its associated costs during the 90-day postoperative period following antireflux surgery.
Methods: We analyzed data from the Truven Health MarketScan® Research Databases. Patients ≥16 years with an ICD-9 procedure code or CPT code for antireflux surgery and a primary diagnosis of GERD during 2012-2014 were selected. Only patients with continuous enrollment six months prior to the date of surgery and 90-days after surgery were analyzed. Patients with a diagnosis of esophageal cancer or achalasia during the six-month period prior to antireflux surgery, a length of stay >30 days following index procedure, a capitated plan, or patients who underwent emergency surgery were excluded. Outpatient endoscopy was defined using ICD-9 and CPT codes, and related readmission was defined by clinical classification software.
Results: 40,853 patients were included with a mean age 49 years. 76% were female. Mean length of stay was 1.41 days and 93% of patients underwent a laparoscopic approach. The majority of patients (96%) did not require a related readmission. 4.2% of patients were readmitted one or more times, and 1.1% of patients required a surgical intervention. 14% of patients presented to the emergency department at least once within 90 days of surgery. 1.5% of patients underwent an outpatient upper endoscopy. The mean cost of the index surgical admission was $24,034.15. Patients requiring one or more related readmissions accrued additional costs of $29,512.97. Emergency department utilization added an additional $926.53 per patient.
Conclusion: The majority of patients undergoing antireflux surgery do not require 90-day post discharge related readmission or endoscopy. However, patients who are readmitted accrue costs that, on average, double the overall cost of care compared to the initial hospitalization. Use of the emergency department was common but contributed much less to the overall cost for these patients. Future examinations into formulating interventions to prevent readmissions after anti-reflux surgery may help to reduce healthcare utilization in this patient population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88075
Program Number: P404
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster