Bariatric surgery outcomes in Medicare beneficiaries.
Medicare
Roux‐en‐Y gastric bypass
bariatric surgery
sleeve gastrectomy
Journal
Obesity science & practice
ISSN: 2055-2238
Titre abrégé: Obes Sci Pract
Pays: United States
ID NLM: 101675151
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
15
01
2020
revised:
10
07
2020
accepted:
10
07
2020
entrez:
12
4
2021
pubmed:
13
4
2021
medline:
13
4
2021
Statut:
epublish
Résumé
The Medicare population is increasing while the prevalence of obesity remains high. Bariatric surgery is the most efficacious treatment of obesity and its comorbidities. The objective of this investigation was to assess trends in utilization, readmission, mortality, and cost of bariatric surgery in the Medicare population. Utilizing the Medicare Provider Analysis and Review database, patients with clinically severe obesity undergoing laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) from 2011-2015 were identified. Trends in procedure selection, readmissions, mortality, and cost were examined. A multivariable logistic regression analysis to evaluate factors associated with readmission and mortality was performed. Of the 73,718 patients identified, 53,949 (73%) of patients were enrolled in Medicare due to disability, 19,191 (26%) due to age, and 578 (<1%) due to end stage renal disease (ESRD). Utilization of SG increased (1% in 2011 to 61% in 2015), while utilization of RYGB (68% to 32%) and LAGB (31% to 1%) decreased. Length of stay (LOS) was highest after RYGB (2.54 days), and lowest after LAGB (1.32 days). LOS decreased from 2.23 days in 2011 to 2.12 days in 2015. Thirty-day readmissions were 8.24% for the disabled, 5.5% for the elderly, 12.8% with ESRD. Odds of readmission increased with black race, higher body mass index (BMI), and RYGB. Readmission decreased from 8% in 2011 to 7% in 2015. Thirty-day mortality was 0.22% in the disabled, and 0.28% in the elderly. Odds of 30-day mortality increased among men, those with higher BMI, some comorbidities, and those who underwent RYGB. Cost of SG decreased while cost of RYGB increased. Among the Medicare population, an increase in SG while a decrease in RYGB and LAGB utilization was noted from 2011-2015. Readmissions and cost have decreased, while mortality has remained low.
Sections du résumé
BACKGROUND
BACKGROUND
The Medicare population is increasing while the prevalence of obesity remains high. Bariatric surgery is the most efficacious treatment of obesity and its comorbidities. The objective of this investigation was to assess trends in utilization, readmission, mortality, and cost of bariatric surgery in the Medicare population.
METHODS
METHODS
Utilizing the Medicare Provider Analysis and Review database, patients with clinically severe obesity undergoing laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) from 2011-2015 were identified. Trends in procedure selection, readmissions, mortality, and cost were examined. A multivariable logistic regression analysis to evaluate factors associated with readmission and mortality was performed.
RESULTS
RESULTS
Of the 73,718 patients identified, 53,949 (73%) of patients were enrolled in Medicare due to disability, 19,191 (26%) due to age, and 578 (<1%) due to end stage renal disease (ESRD). Utilization of SG increased (1% in 2011 to 61% in 2015), while utilization of RYGB (68% to 32%) and LAGB (31% to 1%) decreased. Length of stay (LOS) was highest after RYGB (2.54 days), and lowest after LAGB (1.32 days). LOS decreased from 2.23 days in 2011 to 2.12 days in 2015. Thirty-day readmissions were 8.24% for the disabled, 5.5% for the elderly, 12.8% with ESRD. Odds of readmission increased with black race, higher body mass index (BMI), and RYGB. Readmission decreased from 8% in 2011 to 7% in 2015. Thirty-day mortality was 0.22% in the disabled, and 0.28% in the elderly. Odds of 30-day mortality increased among men, those with higher BMI, some comorbidities, and those who underwent RYGB. Cost of SG decreased while cost of RYGB increased.
CONCLUSIONS
CONCLUSIONS
Among the Medicare population, an increase in SG while a decrease in RYGB and LAGB utilization was noted from 2011-2015. Readmissions and cost have decreased, while mortality has remained low.
Identifiants
pubmed: 33841887
doi: 10.1002/osp4.462
pii: OSP4462
pmc: PMC8019272
doi:
Types de publication
Journal Article
Langues
eng
Pagination
176-191Subventions
Organisme : NIDDK NIH HHS
ID : T32 DK108733
Pays : United States
Informations de copyright
© 2020 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.
Déclaration de conflit d'intérêts
The institution has received grant support from Medtronic inc. The authors have received statistical support from Medtronic Inc. on this manuscript. Daniel B. Leslie also reports receiving consulting fees from Medtronic Inc.Keith Wirth*: Manuscript writing and revision, and figure creation. Scott Kizy*: Manuscript writing and revision, and figure creation. Hisham Abdelwahab: Design and manuscript revision. Jianying Zhang: Statistical analysis and manuscript revision. Santosh Agarwal: Statistical analysis and manuscript revision. Sayeed Ikramuddin: Design and manuscript revision, Daniel B. Leslie: Study conceptualization, design, and manuscript revision. *Denotes equal contribution.
Références
Obes Res. 2004 Sep;12(9):1426-34
pubmed: 15483207
NCHS Data Brief. 2020 Feb;(360):1-8
pubmed: 32487284
Surg Obes Relat Dis. 2017 Aug;13(8):1284-1289
pubmed: 28583812
Br J Surg. 2017 Feb;104(3):248-256
pubmed: 27901287
Ann Surg. 2017 Jul;266(1):105-110
pubmed: 27607102
Surg Obes Relat Dis. 2017 Apr;13(4):575-580
pubmed: 28214166
Obes Surg. 2016 Jul;26(7):1371-7
pubmed: 26715330
Med Care. 2018 Jul;56(7):583-588
pubmed: 29762271
Obes Surg. 2017 Jan;27(1):154-161
pubmed: 27342739
N Engl J Med. 2017 Feb 16;376(7):641-651
pubmed: 28199805
Surg Obes Relat Dis. 2015 Mar-Apr;11(2):419-23
pubmed: 25813752
Cell Metab. 2016 Apr 12;23(4):591-601
pubmed: 26916363
J Am Coll Surg. 2015 Jul;221(1):220-7
pubmed: 26047761
J Manag Care Spec Pharm. 2019 Sep;25(9):973-983
pubmed: 31313621
Lancet Diabetes Endocrinol. 2015 Nov;3(11):855-65
pubmed: 26386667
Lancet Diabetes Endocrinol. 2014 Dec;2(12):954-62
pubmed: 25459211
J Am Coll Surg. 2015 May;220(5):880-5
pubmed: 25907869
Ann Surg. 2016 Oct;264(4):674-81
pubmed: 27433906
N Engl J Med. 2007 Aug 23;357(8):753-61
pubmed: 17715409
JAMA. 2013 Jun 5;309(21):2240-9
pubmed: 23736733
JAMA Surg. 2014 May;149(5):475-81
pubmed: 24623106
Obesity (Silver Spring). 2013 Dec;21(12):E798-804
pubmed: 23804319
PLoS One. 2012;7(3):e32506
pubmed: 22412881
Diabet Med. 1990 Mar-Apr;7(3):228-33
pubmed: 2139394
JAMA. 2013 Dec 11;310(22):2416-25
pubmed: 24189773
Gerontol Geriatr Med. 2016 Jan 19;2:2333721415622004
pubmed: 28138482
Lancet. 2015 Sep 5;386(9997):964-73
pubmed: 26369473
Obes Surg. 2017 Nov;27(11):2951-2955
pubmed: 28500419
Obes Surg. 2017 Nov;27(11):2933-2939
pubmed: 28534189
Health Aff (Millwood). 2007 Jul-Aug;26(4):1111-7
pubmed: 17630454
Diabetes Care. 2000 Oct;23(10):1499-504
pubmed: 11023143
JAMA Surg. 2017 Sep 1;152(9):835-842
pubmed: 28514487
J Gastrointest Surg. 2012 Jan;16(1):35-44; discussion 44
pubmed: 22038414
Surg Obes Relat Dis. 2017 Sep;13(9):1476-1483
pubmed: 28438494
Ann Surg. 2013 May;257(5):791-7
pubmed: 23470577
JAMA Cardiol. 2019 Jan 1;4(1):16-22
pubmed: 30516798
Obesity (Silver Spring). 2014 Jan;22(1):5-13
pubmed: 24307184
J Gastrointest Surg. 2015 Jan;19(1):171-8; discussion 178-9
pubmed: 25186073