Acute Care Utilization and Costs Up to 4 Years After Index Sleeve Gastrectomy or Roux-en-Y Gastric Bypass: A National Claims-Based Study

Journal Article

OBJECTIVE: To compare acute care utilization and costs following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYBG). SUMMARY BACKGROUND DATA: Comparing post-bariatric emergency department (ED) and inpatient care use patterns could assist with procedure choice and provide insights about complication risk. METHODS: We used a national insurance claims database to identify adults undergoing SG and RYBG between 2008 and 2016. Patients were matched on age, gender, calendar-time, diabetes, and baseline acute care use. We used adjusted Cox proportional hazards to compare acute care utilization and two-part logistic regression models to compare annual associated costs (odds of any cost, and odds of high costs, defined as >/=80th percentile), between SG and RYGB, overall and within several clinical categories. RESULTS: The matched cohort included 4263 SG and 4520 RYBG patients. Up to 4 years after surgery, SG patients had slightly lower risk of ED visits (aHR: 0.90; 95% CI: 0.85,0.96) and inpatient stays (aHR: 0.80; 95% CI: 0.73,0.88), especially for events associated with digestive-system diagnoses (ED aHR: 0.68; 95% CI:0.62,0.75; inpatient aHR: 0.61; 95% CI: 0.53,0.72). SG patients also had lower odds of high ED and high total acute costs (e.g., year-1 acute costs aOR 0.77; 95% CI: 0.66,0.90) in early follow-up. However, observed cost differences decreased by years 3 and 4 (e.g., year-4 acute care costs aOR 1.10; 95% CI: 0.92,1.31). CONCLUSIONS: SG may have fewer complications requiring emergency care and hospitalization, especially as related to digestive system disease. However, any acute care cost advantages of SG may wane over time.

Full Text

Duke Authors

Cited Authors

  • Callaway, K; Argetsinger, S; Wharam, JF; Zhang, F; Arterburn, DE; Fernandez, A; Ross-Degnan, D; Wallace, J; Lewis, KH

Published Date

  • 2021

Published In

International Standard Serial Number (ISSN)

  • 1528-1140

Digital Object Identifier (DOI)

  • 10.1097/SLA.0000000000004972