Increasing the Value of Healthcare: Improving Mortality While Reducing Cost in Bariatric Surgery

doi:10.1007/s11695-015-1710-y

. 2015 Dec;25(12):2231-8.

doi: 10.1007/s11695-015-1710-y.

Increasing the Value of Healthcare: Improving Mortality While Reducing Cost in Bariatric Surgery

Ryan C Broderick¹, Hans F Fuchs^{2

3}, Cristina R Harnsberger⁴, David C Chang^{5

6}, Bryan J Sandler⁷, Garth R Jacobsen⁸, Santiago Horgan⁹

Affiliations

¹ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. rbroderick@ucsd.edu.
² Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. hfuchs@ucsd.edu.
³ Department of Surgery, University of Cologne, Cologne, Germany. hfuchs@ucsd.edu.
⁴ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. charnsberger@ucsd.edu.
⁵ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. dchang8@mgh.harvard.edu.
⁶ Department of Surgery, Harvard Medical School-Codman Center, Massachusetts General Hospital, Boston, MA, USA. dchang8@mgh.harvard.edu.
⁷ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. bsandler@ucsd.edu.
⁸ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. gjacobsen@ucsd.edu.
⁹ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. shorgan@ucsd.edu.

PMID: 25986426
DOI: 10.1007/s11695-015-1710-y

Increasing the Value of Healthcare: Improving Mortality While Reducing Cost in Bariatric Surgery

Ryan C Broderick et al. Obes Surg. 2015 Dec.

. 2015 Dec;25(12):2231-8.

doi: 10.1007/s11695-015-1710-y.

Authors

Ryan C Broderick¹, Hans F Fuchs^{2

3}, Cristina R Harnsberger⁴, David C Chang^{5

6}, Bryan J Sandler⁷, Garth R Jacobsen⁸, Santiago Horgan⁹

Affiliations

¹ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. rbroderick@ucsd.edu.
² Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. hfuchs@ucsd.edu.
³ Department of Surgery, University of Cologne, Cologne, Germany. hfuchs@ucsd.edu.
⁴ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. charnsberger@ucsd.edu.
⁵ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. dchang8@mgh.harvard.edu.
⁶ Department of Surgery, Harvard Medical School-Codman Center, Massachusetts General Hospital, Boston, MA, USA. dchang8@mgh.harvard.edu.
⁷ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. bsandler@ucsd.edu.
⁸ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. gjacobsen@ucsd.edu.
⁹ Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Ave, MC 0740, San Diego, CA, 92093, USA. shorgan@ucsd.edu.

PMID: 25986426
DOI: 10.1007/s11695-015-1710-y

Abstract

Background: Healthcare costs in the United States (U.S.) are rising. As outcomes improve, such as decreased length of stay and decreased mortality, it is expected that costs should go down. The aim of this study is to analyze hospital charges, cost of care, and mortality in bariatric surgery over time.

Methods: A retrospective analysis of the Nationwide Inpatient Sample (NIS) database was performed. Adults with morbid obesity who underwent gastric bypass or sleeve gastrectomy were identified by ICD-9 codes. Multivariate analyses identified independent predictors of changes in hospital charges and in-hospital mortality. Results were adjusted for age, race, gender, Charlson comorbidity index, surgical approach (open versus laparoscopic), hospital volume, and insurance status. In order to estimate baseline surgical inflation, changes in hospital charges over time were also calculated for appendectomy.

Results: From 1998 to 2011, 209,106 patients were identified who underwent bariatric surgery. Adjusted in-hospital mortality for bariatric surgery decreased significantly by 2003 compared to 1998 (p < 0.001, OR 0.47, 95 % CI 0.22-0.92) and remained significantly decreased for the remainder of the study period. As such, a 60-80 % decrease in mortality was maintained from 2003 to 2010 compared to 1998. After adjusting for inflation, the cumulative increase in hospital charges per day of a bariatric surgery admission was 130 % from 1998 to 2011. Charges per stay increased by 2.1 % annually for bariatric surgery compared to 5.5 % for appendectomy.

Conclusion: In-hospital mortality rate following bariatric surgery underwent a ninefold decrease since 1998 while maintaining surgical inflation costs less than appendectomy. Innovation in bariatric surgical technique and technology has resulted in improvement of outcomes while providing overall cost savings.

Keywords: Bariatric surgery; Outcomes; Population database; Value.

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[1] Emerg Med J. 2008 Mar;25(3):149-52 - PubMed

[2] Emerg Med J. 2008 Mar;25(3):149-52 - PubMed

[3] Surg Endosc. 2005 May;19(5):616-20 - PubMed

[4] Surg Endosc. 2005 May;19(5):616-20 - PubMed

[5] MMWR Suppl. 2013 Nov 22;62(3):120-8 - PubMed

[6] MMWR Suppl. 2013 Nov 22;62(3):120-8 - PubMed

[7] Neurosurgery. 2003 May;52(5):1056-63; discussion 1063-5 - PubMed

[8] Neurosurgery. 2003 May;52(5):1056-63; discussion 1063-5 - PubMed

[9] N Engl J Med. 2010 Dec 23;363(26):2477-81 - PubMed

[10] N Engl J Med. 2010 Dec 23;363(26):2477-81 - PubMed

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Increasing the Value of Healthcare: Improving Mortality While Reducing Cost in Bariatric Surgery

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Increasing the Value of Healthcare: Improving Mortality While Reducing Cost in Bariatric Surgery

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