Paper
Hospital costs associated with bariatric procedures in the United States

Presented at the 29th Annual Surgical Symposium of the Association of VA Surgeons, Salt Lake City, Utah, March 11–13, 2005
https://doi.org/10.1016/j.amjsurg.2005.07.026Get rights and content

Abstract

Background

Weight loss operations are being performed at an exponentially increasing rate. Although highly effective for controlling obesity and its complications, the operations are expensive. The operations are thought to be cost-effective, but there has not been an analysis of the costs associated with these procedures at a national level precluding definitive cost-effectiveness studies useful for policy determination.

Methods

The 2001 and 2002 National Inpatient Survey (NIS) was used to establish costs attributable to bariatric surgery. This survey contains discharge information for approximately 20% of all US hospital admissions in any given year. Bariatric procedures were identified by ICD-9-CM procedures codes and diagnostic related group (DRG) 288 (operating room [OR] procedures for obesity).

Results

Of the commonly performed operations, laparoscopic gastric bypass had the lowest hospital charges ($19,794/case) relative to open gastric bypass ($22,313/case) and laparoscopic banding procedures ($25,355/case). Laparoscopic gastric bypass resulted in fewer charges because of a 1-day shorter median length of stay.

Discussion

These data provide benchmarks for the costs associated with the weight loss procedures commonly performed in the United States. Although laparoscopic gastric bypass is the lease costly approach to bariatric surgery, the fact that costs are lower because of decreased length of stay can be disadvantageous for hospitals reimbursed on a per diem basis.

Section snippets

Methods

The NIS was obtained from the Agency for Healthcare Research and Quality (AHRQ) for the years 2001 and 2002 [5]. These years were selected because they had very large numbers of bariatric procedures performed by open and laparoscopic techniques. Hospital discharges encoded with diagnostic related group (DRG) 288 were selected from the databases. DRGs are assigned at the time of a patients discharge based on combinations of diagnostic and procedure codes along with information from the patient’s

Results

The NIS database for 2001 contained 10,762 records for bariatric procedures, representative of 53,239 operations performed in the United States for that year. There were 14,682 records for 2002, representing 71,098 procedures. Of all the bariatric procedures, 84% were performed on females. The overall in-hospital mortality was .3% with an overall adverse event rate of 9%. Of the procedures, 59% were open gastric bypasses and 14% laparoscopic Roux-en-Y gastric bypasses (RYGBs). There were 879

Comments

Our study demonstrated that of the commonly performed weight loss procedures, overall hospitalization costs are the least with laparoscopic gastric bypass. Consistent with our initial impression, procedure costs are higher for laparoscopic relative to open gastric bypass as evidenced by higher per diem charges. However, the 1-day shorter median length of stay attributable to laparoscopic approach results in lower overall hospital costs.

Unfortunately, reimbursements do not always follow true

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