Establishing a laparoscopic bariatric program in a safety net hospital

Surg Endosc. 2007 May;21(5):801-4. doi: 10.1007/s00464-006-9039-1. Epub 2006 Dec 16.


Background: Most laparoscopic bariatric programs are situated in a community- or university-based hospital. The authors have recently initiated a program at a safety net hospital. This investigation hypothesizes that a laparoscopic bariatric program can be established at a safety net hospital with good clinical and financial results.

Methods: A laparoscopic bariatric program was initiated December 2002 at a safety net hospital. The program included a dedicated operative suite, an operative team, a bariatric unit, and a clinical pathway. The data for all the patients who underwent laparoscopic gastric bypasses up to June 2003 were analyzed. The patients were analyzed by type of insurance: government-sponsored insurance (G) or commercial insurance (C).

Results: There were 104 patients during this period. Their mean age was 40 years (range, 18-63 years), and their mean body mass index was 48 (range, 38-62). The median length of hospital stay was 2 days (mean, 3.9 days). Hypertension and diabetes were resolved for more than 80% of the patients. The average percentage of excess body weight loss was 73% after 1 year. There were no significant clinical differences between payor groups. The payor mix was 31% G and 69% C. The mean collection rates for hospital charges were 10% for G versus 53% for C (p < 0.0001).

Conclusions: A laparoscopic bariatric program can be established in a safety net hospital with good clinical results. Findings showed that 1-year weight loss and comorbidity improvement/resolution compares favorably with those of other programs. Despite the overall poor payor mix of many safety net hospitals, a bariatric program can be established and can attract a high rate of commercially insured patients.

MeSH terms

  • Adult
  • Bariatric Surgery* / economics
  • Commerce
  • Cost Allocation
  • Female
  • Financing, Government
  • Hospitals*
  • Humans
  • Laparoscopy* / economics
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery
  • Program Development*
  • Reimbursement Mechanisms
  • Treatment Outcome
  • Uncompensated Care*