Establishing a laparoscopic bariatric program in a safety net hospital.
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.
Madan
A K
AK
Department of Surgery, University of Tennessee Health Science Center, 956 Court Avenue, Room G210, Memphis, TN 38163, USA. amadan@utmem.edu
Tichansky
D S
DS
Ternovits
C A
CA
Speck
K E
KE
Steinhauer
B W
BW
Croce
M A
MA
Fabian
T C
TC
D000328:Adult; D050110:Bariatric Surgery / Q000191:economics; D003132:Commerce; D003361:Cost Allocation; D005260:Female; D005380:Financing, Government; D006761:Hospitals; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D016730:Program Development; D012051:Reimbursement Mechanisms; D016896:Treatment Outcome; D017664:Uncompensated Care