Establishing a laparoscopic bariatric program in a safety net hospital

• Published in: Surgical endoscopy Vol. 21; no. 5; pp. 801 - 804
• Main Authors: MADAN, A. K, TICHANSKY, D. S, TERNOVITS, C. A, SPECK, K. E, STEINHAUER, B. W, CROCE, M. A, FABIAN, T. C
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.05.2007; Springer Nature B.V
• Subjects: Adult; Bariatric Surgery - economics; Biological and medical sciences; Commerce; Comorbidity; Cost Allocation; Digestive system. Abdomen; Endoscopy; Female; Financing, Government; Gastrointestinal surgery; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - economics; Length of stay; Male; Medical sciences; Middle Aged; Nurses; Obesity; Obesity, Morbid - surgery; Patient care planning; Program Development; Reimbursement Mechanisms; Surgeons; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Uncompensated Care; Weight control; Stomach; Treatment; Bariatric surgery ¯ Charges ¯ Collection rate ¯ Laparoscopic gastric bypass ¯ Payor mix¯ Safety net hospital; Bypass; Bariatric surgery; Laparoscopic surgery; Laparoscopy; Endoscopy; Hospital
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-006-9039-1

Most laparoscopic bariatric programs are situated in a community- or university-based hospital. The authors have recently initiated a program at a safety net hospital. This investigation hypothesizes that a laparoscopic bariatric program can be established at a safety net hospital with good clinical and financial results. A laparoscopic bariatric program was initiated December 2002 at a safety net hospital. The program included a dedicated operative suite, an operative team, a bariatric unit, and a clinical pathway. The data for all the patients who underwent laparoscopic gastric bypasses up to June 2003 were analyzed. The patients were analyzed by type of insurance: government-sponsored insurance (G) or commercial insurance (C). There were 104 patients during this period. Their mean age was 40 years (range, 18-63 years), and their mean body mass index was 48 (range, 38-62). The median length of hospital stay was 2 days (mean, 3.9 days). Hypertension and diabetes were resolved for more than 80% of the patients. The average percentage of excess body weight loss was 73% after 1 year. There were no significant clinical differences between payor groups. The payor mix was 31% G and 69% C. The mean collection rates for hospital charges were 10% for G versus 53% for C (p < 0.0001). A laparoscopic bariatric program can be established in a safety net hospital with good clinical results. Findings showed that 1-year weight loss and comorbidity improvement/resolution compares favorably with those of other programs. Despite the overall poor payor mix of many safety net hospitals, a bariatric program can be established and can attract a high rate of commercially insured patients.