Predictors of high cost after bariatric surgery: A single institution review.

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.