Vikrom K Dhar, MD, Koffi Wima, MS, Brad M Watkins, Shimul A Shah, MD, Jonathan R Thompson, MD. University of Cincinnati
Objective: Determinants of cost for laparoscopic sleeve gastrectomy (LSG) are poorly defined. We aim to characterize the variability in cost for LSG at the national level and identify which factors are predictive of increased cost.
Methods: Using the University HealthSystems Consortium database, we identified 22,035 patients who underwent LSG between 2012-2014. Patients were grouped into tertiles (low, medium, high) according to cost of perioperative stay.
Results: Patients undergoing LSG were of similar age and gender across all three groups. High cost patients were more often black (26.7% vs. 22.3% vs. 18.3%, p < 0.01), insured by Medicare/Medicaid (33.8% vs. 25.5% vs. 19.9%, p < 0.01) and diagnosed with increased severity of illness (48.3% moderate/major vs. 40.1% vs. 34.3%, p < 0.01) compared to medium and low cost patients. Although high cost patients were shown to have clinically similar lengths of stay (2 days vs. 2 vs. 2), these patients had higher 30-day readmission rates (5.3% vs. 3.4% vs. 3.1%, p < 0.01). Interestingly, low cost patients were more often operated on by high volume surgeons (40.3% vs. 34.1% vs. 29.7%, p < 0.01). On multivariate analysis, black race, government insurance, and increased severity of illness remained significant predictors of increased cost for LSG (all p < 0.01).
Conclusion: Variability in cost for LSGs performed at academic medical centers is significantly associated with patient factors including race, insurance status, and severity of illness. These findings support further research into risk-adjusted bundled reimbursement policies for LSG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88043
Program Number: P641
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster