Calculating surgical costs: how accurate and predictable is the cost of a laparoscopic Roux-en-Y gastric bypass?
BACKGROUND
Although bariatric surgery is highly effective for controlling obesity and its complications, it is uncovered by third-party payers in many countries. High cost and unpredictable expenses account for the lack of coverage. We developed at our obesity clinic a fixed package for the Laparoscopic Roux-en-Y Gastric Bypass (LRYGBP). The aim of this study is to evaluate the predictability and reproducibility of the estimated expenses in the first 150 consecutive patients who underwent LRYGBP as initial procedure.


METHODS
A fixed package which included hospitalization, operative room expenses, medications, multidisciplinary support, and professional honorarium was established based on the experience gained with more than 500 preceding interventions. Actual direct medical costs of the initial 150 patients who underwent LRYGBP by one surgeon were analyzed and contrasted to the anticipated expenses.


RESULTS
Mean age was 35.8 +/- 11.8 years (range 16-69 years). Average body mass index (BMI) was 43.1 +/- 4.8 kg/m(2) (range 35-70). Mean number of comorbidities per patient were 1.7 +/- 0.8 (range 1-5). All patients completed a LRYGBP with no conversions. Mean hospital stay was 3 +/- 0.3 days. Complications occurred in 13 patients. Mean total expenses were 98.5 +/- 10% of the estimated costs. In 143 patients (95.3%), the total expenses were within 10% of the estimated costs, whereas in five they were > or =10% and in two > or =20%.


CONCLUSIONS
Costs of a LRYGBP can be accurately predicted and are highly reproducible when interventions are performed by an experienced team and potentially lethal complications do not occur.
The Obesity Clinic, American British Cowdray Medical Center, Sur 136 # 116 Colonia Las Américas, 01120 Mexico City, Mexico.
Maureen
M
Mosti
Guillermo
G
Domínguez
Miguel F
MF
Herrera
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies