title: Predictors of high cost after bariatric surgery: A single institution review.
abstract: Drivers of high cost care after bariatric operation have not been well described. We sought to compare 1-year costs between patients who underwent laparoscopic vertical sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass and identify predictors of high cost of care.
  
  
  
  Morbidly obese patients who underwent laparoscopic vertical sleeve gastrectomy (n = 74) or laparoscopic Roux-en-Y gastric bypass (n = 270) at a single institution from 2010-2014 were identified. Patient demographic characteristics, surgeon age, 90-day and 1-year surgical outcomes, and facility cost data were collected. "High cost" patients were defined as those in the top quartile of costs among all patients. Variables hypothesized a priori to be associated with high total costs were included in a bivariate logistic regression model. Those with a P value < .1 were included in a multivariable logistic regression model with "high cost" as the outcome.
  
  
  
  Laparoscopic vertical sleeve gastrectomy was associated with slightly greater median total 1-year costs ($18,234 vs $17,151; P = .021) and inpatient costs ($15,026 vs $13,990; P = .019). On multivariable analysis, having Medicaid (odds ratio 2.72; 95% confidence interval, 1.47-5.06) compared with private insurance, being readmitted to the hospital (odds ratio 5.48; 95% confidence interval, 2.45-12.26), and experiencing a postoperative complication (odds ratio 4.12; 95% confidence interval, 1.79-9.48) were associated with high-cost care.
  
  
  
  Suboptimal operative outcomes seem to be the primary driver of high overall costs after bariatric operation. Improving postoperative outcomes may result in substantial cost savings.
authors: School of Medicine and Public Health, University of Wisconsin, Madison, WI.
authors: Neil
authors: N
authors: Shah
authors: School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Surgery, University of Wisconsin, Madison, WI.
authors: Jacob A
authors: JA
authors: Greenberg
authors: Department of Surgery, University of Wisconsin, Madison, WI.
authors: Glen
authors: G
authors: Leverson
authors: School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Surgery, University of Wisconsin, Madison, WI. Electronic address: funk@surgery.wisc.edu.
authors: Luke M
authors: LM
authors: Funk
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017048:Health Care Costs; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011182:Postoperative Care / Q000191:economics / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014481:United States