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The effect of procedure choice. LRYGB vs LSG
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232 A5134
PATIENT PORTRAYALS AND RECOMMENDATIONS ABOUT WEIGHT LOSS SURGERY EDUCATION Karen Groller; Moravian College, Bethlehem PA Background: Weight recidivism can result from failed behavioral modifications after Weight Loss Surgery (WLS). Education plays a key role in habit formation and adherence to lifestyle changes throughout the WLS process. Although MBSAQIP established patient education minimums in 2014,1 weight loss surgery (WLS) patient education practices is based mostly on expert recommendation, rather than research findings.2 Investigation of WLS education practices is needed to examine how effective education before and after WLS may decrease recidivism rates and improve outcomes. A qualitative study was conducted to obtain patient descriptions about education received and subsequent satisfaction level. Findings about the education experienced by patients, in regards to curricula, teaching methods, educator, and educational dose will be shared. Study results can guide future improvements in the educational experience, which may positively influence clinical outcomes for future patients. Methods: A qualitative descriptive design was used. Semistructured interviews occurred after participants were identified through purposive random sampling. Patients who had WLS 12-18 months prior at one MBSAQIP Weight Management Center in the Northeastern United States were invited. Patients were excluded if they were under the age of 18, non-English speaking, had a surgical revision, or lived with a partner who also had WLS. Inductive content analysis was performed to identify emergence of common themes. Member-checking confirmed final themes. Results: As part of the larger study, data saturation was established with eleven interviews (36% male) and resulted in three final themes. Theme One: Programming and Tools illustrated patients' portrayal about educational and supportive programming received before, during, and after their WLS through five subthemes-Catalyst for Change, WLS Education Programs, WLS Support Programs, Resource Materials, and Client Engagement. In Catalyst for Change, patients perceived WLS as a tool that could stimulate healthy lifestyle changes when accompanied with personal accountability. Four categories of educational programs and three types of supportive programs were described before and after WLS. The sub-themes WLS Education Programs and WLS Support Programs also explained the curricula, activities, content delivery, and educational dose for program types. Resource Materials included details about oral, written and digital venues that were used by participants for educational purposes. Resources provided by the Weight Management Center and independently discovered by the patient were revealed. Lastly, Client Engagement explained most patients experienced passive learning principles during their WLS education. Patients who took personal responsibility after attending educational sessions to use the information acquired were more satisfied with their results. Active participation was described as vital for optimal outcomes. Conclusions: This study obtained patient views about WLS education and subsequent level of satisfaction with the experiences. Types of educational and supportive programs were identified, found to be fairly congruent to MBSAQIP Standards, and deemed necessary by patients to support WLS lifestyle. Results can inform MBSAQIP standards, refine education practices, and urge research on the impact WLS patient education has
S137
on clinical outcomes. These results intend to add to the existing literature and recommend continued research to develop quality, cost-effective, patient-centered programs in WLS. References1. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Resources for optimal care of the metabolic and bariatric surgery patient 2014. Standard 5.1 Patient Education Protocols. Chicago, IL: American College of Surgeons; 2014.2. Groller, K.D. The State of Weight Loss Surgery Patient Education: An Examination of the Evidence. Surgery for Obesity and Related Diseases 11.6 (Nov-Dec 2015): S46. Web.
A5135
IS BARIATRIC SURGERY A LUXURY? PRIVATELYINSURED AND SELF-PAY PATIENTS UNDERGO MORE AND SAFER BARIATRIC SURGERY Dietric Hennings; Christopher DuCoin; Zaid Al-Qurayshi; Tulane University Medical Center, New Orleans Louisiana Background: One third of adults in the United States are affected by obesity. Bariatricsurgery has been shown to be the most effective method of achieving weight loss anddiminishing the comorbidities of obesity. Despite these positive outcomes, there may bedisparities that exist within the patient population. This study seeks to identify possibledisparity in the payer status of patients undergoing bariatric surgery. Materials and Methods: We performed a retrospective, crosssectional analysis of theNational Inpatient Sample database, the largest all-payer inpatient database, from 2003-2010. We identified adults who underwent bariatric surgery and matched them withappropriate controls. Our primary objective was to examine patients' demographic andeconomic characteristics, including payer status, hospital region, rural or urban hospitaland academic or community practice. The sample was analyzed using Chisquared tests,linear regression analysis, and multivariate logistical regression analysis. Results: A total of 132,342 cases and 636,320 controls were studied. The majority of thestudy sample was female (66.5%), white (70.0%), and had private insurance (42.0%).Medicare (5.1% (OR 0.33, 95% CI 0.29-0.37, po0.001) and Medicaid (8.7%, OR 0.21, CI 95%0.18-0.25, po0.001) patients account for a lower percentage of bariatric cases aftercontrolling for demographic factors. Additionally, public payer status conferred highercomplication rates; Medicare OR 1.54 (95% CI: 1.33, 1.78; po0.001) and Medicaid OR 1.31(95% CI: 1.08, 1.60; p¼0.007). Conclusions: Public payer status is associated with disparity in delivery of bariatric surgery.This population is also more likely to experience a complication after bariatric surgery.
A5136
THE EFFECT OF PROCEDURE CHOICE. LRYGB VS LSG Federico Perez Quirante1; Lisandro Montorfano1; Hira Ahmad1; Emanuele Lo Menzo1; Samuel Szomstein1; Raul Rosenthal2; 1 Cleveland Clinic, Florida, Weston Fl; 2Cleveland Clinic of FL, Weston Fl Introduction: Although the long term economic impact of bariatric surgery is well appreciated, its immediate costs are less
S138
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
well studied. The purpose of this study is to analyze in detail the effect of procedure choice in bariatric surgery costs. We have performed a controlled model where we look at final surgical expense as well as the breakdown for each part of the hospital course of a bariatric patient. Methods: Cost data was collected directly from the financial department of our hospital. The total costs derived from different costs centers. Each cost center represents a different department or service of our hospital that encountered expenses for that particular patient. A model was fitted to control for different presurgical factors: Demographics (Age, sex, race, preoperative BMI), Comorbidities (Diabetes II, hypertension, history of tobacco use, sleep apnea, GERD) and surgical (length of stay, procedure type, concurrent minor procedure) These models treat the outcome cost as an ordinal variable and describe the odds of having a higher cost. For each model, all relevant variables were included and the variables that had no impact were eliminated. A 'Normalized total
cost' was calculated by dividing the total cost divided by the mean total cost. The impact of each procedure choice was then analyzed. Results: A total of 458 patients were included in the study, 65 underwent LRYGB and 393 LSG. The impact of procedure choice of several cost centers as well as its effect on the grand total is presented on table 1. These models treat the outcome cost as an ordinal variable and describe the odds of having a higher cost. LRYGB was associated with higher costs in Anesthesia, OR supplies, General lab, General radiology, Ultrasound, Operating room costs, physical therapy costs and total costs. LSG was related with higher pathology costs. Telemetry, ICU, Intermidiate ICU, Pacu, Med/surg floor, Pharmacy were not associated with higher cost in any procedure. Conclusion: According to our data, LRYGB is significantly more expensive than LSG. Most of the differences seen have to do with a longer surgery, need for more surgical supplies and need for a closer postoperative care. LSG is a successful bariatric technique that offers similar weight loss over time but a much lower cost.
PATIENT PORTRAYALS AND RECOMMENDATIONS ABOUT WEIGHT LOSS SURGERY EDUCATION Karen Groller; Moravian College, Bethlehem PA Background: Weight recidivism can result from failed behavioral modifications after Weight Loss Surgery (WLS). Education plays a key role in habit formation and adherence to lifestyle changes throughout the WLS process. Although MBSAQIP established patient education minimums in 2014,1 weight loss surgery (WLS) patient education practices is based mostly on expert recommendation, rather than research findings.2 Investigation of WLS education practices is needed to examine how effective education before and after WLS may decrease recidivism rates and improve outcomes. A qualitative study was conducted to obtain patient descriptions about education received and subsequent satisfaction level. Findings about the education experienced by patients, in regards to curricula, teaching methods, educator, and educational dose will be shared. Study results can guide future improvements in the educational experience, which may positively influence clinical outcomes for future patients. Methods: A qualitative descriptive design was used. Semistructured interviews occurred after participants were identified through purposive random sampling. Patients who had WLS 12-18 months prior at one MBSAQIP Weight Management Center in the Northeastern United States were invited. Patients were excluded if they were under the age of 18, non-English speaking, had a surgical revision, or lived with a partner who also had WLS. Inductive content analysis was performed to identify emergence of common themes. Member-checking confirmed final themes. Results: As part of the larger study, data saturation was established with eleven interviews (36% male) and resulted in three final themes. Theme One: Programming and Tools illustrated patients' portrayal about educational and supportive programming received before, during, and after their WLS through five subthemes-Catalyst for Change, WLS Education Programs, WLS Support Programs, Resource Materials, and Client Engagement. In Catalyst for Change, patients perceived WLS as a tool that could stimulate healthy lifestyle changes when accompanied with personal accountability. Four categories of educational programs and three types of supportive programs were described before and after WLS. The sub-themes WLS Education Programs and WLS Support Programs also explained the curricula, activities, content delivery, and educational dose for program types. Resource Materials included details about oral, written and digital venues that were used by participants for educational purposes. Resources provided by the Weight Management Center and independently discovered by the patient were revealed. Lastly, Client Engagement explained most patients experienced passive learning principles during their WLS education. Patients who took personal responsibility after attending educational sessions to use the information acquired were more satisfied with their results. Active participation was described as vital for optimal outcomes. Conclusions: This study obtained patient views about WLS education and subsequent level of satisfaction with the experiences. Types of educational and supportive programs were identified, found to be fairly congruent to MBSAQIP Standards, and deemed necessary by patients to support WLS lifestyle. Results can inform MBSAQIP standards, refine education practices, and urge research on the impact WLS patient education has
S137
on clinical outcomes. These results intend to add to the existing literature and recommend continued research to develop quality, cost-effective, patient-centered programs in WLS. References1. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Resources for optimal care of the metabolic and bariatric surgery patient 2014. Standard 5.1 Patient Education Protocols. Chicago, IL: American College of Surgeons; 2014.2. Groller, K.D. The State of Weight Loss Surgery Patient Education: An Examination of the Evidence. Surgery for Obesity and Related Diseases 11.6 (Nov-Dec 2015): S46. Web.
A5135
IS BARIATRIC SURGERY A LUXURY? PRIVATELYINSURED AND SELF-PAY PATIENTS UNDERGO MORE AND SAFER BARIATRIC SURGERY Dietric Hennings; Christopher DuCoin; Zaid Al-Qurayshi; Tulane University Medical Center, New Orleans Louisiana Background: One third of adults in the United States are affected by obesity. Bariatricsurgery has been shown to be the most effective method of achieving weight loss anddiminishing the comorbidities of obesity. Despite these positive outcomes, there may bedisparities that exist within the patient population. This study seeks to identify possibledisparity in the payer status of patients undergoing bariatric surgery. Materials and Methods: We performed a retrospective, crosssectional analysis of theNational Inpatient Sample database, the largest all-payer inpatient database, from 2003-2010. We identified adults who underwent bariatric surgery and matched them withappropriate controls. Our primary objective was to examine patients' demographic andeconomic characteristics, including payer status, hospital region, rural or urban hospitaland academic or community practice. The sample was analyzed using Chisquared tests,linear regression analysis, and multivariate logistical regression analysis. Results: A total of 132,342 cases and 636,320 controls were studied. The majority of thestudy sample was female (66.5%), white (70.0%), and had private insurance (42.0%).Medicare (5.1% (OR 0.33, 95% CI 0.29-0.37, po0.001) and Medicaid (8.7%, OR 0.21, CI 95%0.18-0.25, po0.001) patients account for a lower percentage of bariatric cases aftercontrolling for demographic factors. Additionally, public payer status conferred highercomplication rates; Medicare OR 1.54 (95% CI: 1.33, 1.78; po0.001) and Medicaid OR 1.31(95% CI: 1.08, 1.60; p¼0.007). Conclusions: Public payer status is associated with disparity in delivery of bariatric surgery.This population is also more likely to experience a complication after bariatric surgery.
A5136
THE EFFECT OF PROCEDURE CHOICE. LRYGB VS LSG Federico Perez Quirante1; Lisandro Montorfano1; Hira Ahmad1; Emanuele Lo Menzo1; Samuel Szomstein1; Raul Rosenthal2; 1 Cleveland Clinic, Florida, Weston Fl; 2Cleveland Clinic of FL, Weston Fl Introduction: Although the long term economic impact of bariatric surgery is well appreciated, its immediate costs are less
S138
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
well studied. The purpose of this study is to analyze in detail the effect of procedure choice in bariatric surgery costs. We have performed a controlled model where we look at final surgical expense as well as the breakdown for each part of the hospital course of a bariatric patient. Methods: Cost data was collected directly from the financial department of our hospital. The total costs derived from different costs centers. Each cost center represents a different department or service of our hospital that encountered expenses for that particular patient. A model was fitted to control for different presurgical factors: Demographics (Age, sex, race, preoperative BMI), Comorbidities (Diabetes II, hypertension, history of tobacco use, sleep apnea, GERD) and surgical (length of stay, procedure type, concurrent minor procedure) These models treat the outcome cost as an ordinal variable and describe the odds of having a higher cost. For each model, all relevant variables were included and the variables that had no impact were eliminated. A 'Normalized total
cost' was calculated by dividing the total cost divided by the mean total cost. The impact of each procedure choice was then analyzed. Results: A total of 458 patients were included in the study, 65 underwent LRYGB and 393 LSG. The impact of procedure choice of several cost centers as well as its effect on the grand total is presented on table 1. These models treat the outcome cost as an ordinal variable and describe the odds of having a higher cost. LRYGB was associated with higher costs in Anesthesia, OR supplies, General lab, General radiology, Ultrasound, Operating room costs, physical therapy costs and total costs. LSG was related with higher pathology costs. Telemetry, ICU, Intermidiate ICU, Pacu, Med/surg floor, Pharmacy were not associated with higher cost in any procedure. Conclusion: According to our data, LRYGB is significantly more expensive than LSG. Most of the differences seen have to do with a longer surgery, need for more surgical supplies and need for a closer postoperative care. LSG is a successful bariatric technique that offers similar weight loss over time but a much lower cost.