Variation in Bariatric Surgery Episode Costs in the Commercially Insured: Implications for Bundled Payments in the Private Sector.


OBJECTIVE:To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. BACKGROUND:Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally. METHODS:We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation. RESULTS:We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments. CONCLUSIONS:Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more likely to be influenced by provider discretion.


Ann Surg


Annals of surgery


Kelsall AC,Cassidy R,Ghaferi AA




Has Abstract


2018-12-01 00:00:00












  • Irrigation versus suction alone during laparoscopic appendectomy for perforated appendicitis: a prospective randomized trial.

    abstract:BACKGROUND:The efficacy of irrigating the peritoneal cavity during appendectomy for perforated appendicitis has been debated extensively. To date, prospective comparative data are lacking. Therefore, we conducted a prospective, randomized trial comparing peritoneal irrigation to suction alone during laparoscopic append...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验


    authors: St Peter SD,Adibe OO,Iqbal CW,Fike FB,Sharp SW,Juang D,Lanning D,Murphy JP,Andrews WS,Sharp RJ,Snyder CL,Holcomb GW,Ostlie DJ

    更新日期:2012-10-01 00:00:00

  • Comparison of randomized controlled trial registry entries and content of reports in surgery journals.

    abstract:OBJECTIVE:To evaluate discrepancies between trial registry entries and final reports of randomized controlled trials (RCTs) published in major general surgical journals. BACKGROUND:Health care decisions are based on published results in peer-reviewed journals. Mandatory trial registration was introduced to increase tr...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Rosenthal R,Dwan K

    更新日期:2013-06-01 00:00:00

  • Association Between Intraoperative Platelet Transfusion and Early Graft Regeneration in Living Donor Liver Transplantation.

    abstract:OBJECTIVE:To evaluate the association between anesthetic management before and after graft reperfusion and early graft regeneration in living donor liver transplantation (LDLT). BACKGROUND:Sufficient graft regeneration is essential for the success of LDLT. Diverse signals start to trigger liver regeneration immediatel...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Han S,Park HW,Song JH,Gwak MS,Lee WJ,Kim G,Lee SK,Ko JS

    更新日期:2016-12-01 00:00:00

  • The effect of mesh removal and selective neurectomy on persistent postherniotomy pain.

    abstract:UNLABELLED:SUMMARY BACKGROUND DATA AND OBJECTIVE: Persistent pain affects everyday activities in 5% to 8% of patients after groin hernia repair. Because previous reports on the effect of neurectomy and/or mesh removal suffer from methodological problems we performed a detailed prospective trial of the effect of neurect...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章


    authors: Aasvang EK,Kehlet H

    更新日期:2009-02-01 00:00:00

  • Prevention of surgical malpractice claims by use of a surgical safety checklist.

    abstract:OBJECTIVE:To assess what proportion of surgical malpractice claims might be prevented by the use of a surgical safety checklist. BACKGROUND:Surgical disciplines are overrepresented in the distribution of adverse events. The recently described multidisciplinary SURgical PAtient Safety System (SURPASS) checklist covers ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: de Vries EN,Eikens-Jansen MP,Hamersma AM,Smorenburg SM,Gouma DJ,Boermeester MA

    更新日期:2011-03-01 00:00:00

  • Pseudomonas aeruginosa expresses a lethal virulence determinant, the PA-I lectin/adhesin, in the intestinal tract of a stressed host: the role of epithelia cell contact and molecules of the Quorum Sensing Signaling System.

    abstract:OBJECTIVE:We have previously demonstrated that P. aeruginosa can have profound effects on the intestinal epithelial barrier via one of its virulence factors, the PA-I lectin/adhesin. The aims of the present study were to further characterize the interaction of P. aeruginosa and the intestinal epithelium using both in v...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Wu L,Holbrook C,Zaborina O,Ploplys E,Rocha F,Pelham D,Chang E,Musch M,Alverdy J

    更新日期:2003-11-01 00:00:00

  • Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study.

    abstract:SUMMARY BACKGROUND DATA:The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these pati...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: van Santvoort HC,Besselink MG,de Vries AC,Boermeester MA,Fischer K,Bollen TL,Cirkel GA,Schaapherder AF,Nieuwenhuijs VB,van Goor H,Dejong CH,van Eijck CH,Witteman BJ,Weusten BL,van Laarhoven CJ,Wahab PJ,Tan AC,Schwartz M

    更新日期:2009-07-01 00:00:00

  • Effects of a stable prostacyclin analog on experimental ischemic acute renal failure.

    abstract::The effect of OP-41483, a stable prostacyclin (PGI2) analog, on ischemic acute renal failure (ARF) was investigated in dogs. Administration of OP-41483 for three days after ischemia significantly increased renal cortical blood flow (RCBF) when compared with dogs treated with the saline vehicle. In the OP-41483-treated...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Tobimatsu M,Ueda Y,Saito S,Tsumagari T,Konomi K

    更新日期:1988-07-01 00:00:00

  • Early postoperative small bowel obstruction.

    abstract::The hospital records of 41 patients with a diagnosis of early postoperative small bowel obstruction were reviewed in an attempt to identify criteria which could be used to separate those patients who would require an operation to resolve their obstruction, from those who would resolve with nonoperative therapy. The us...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Quatromoni JC,Rosoff L Sr,Halls JM,Yellin AE

    更新日期:1980-01-01 00:00:00

  • Controlled clinical trial of selective decontamination for the treatment of severe acute pancreatitis.

    abstract:OBJECTIVE:A randomized, controlled, multicenter trial was undertaken in 102 patients with objective evidence of severe acute pancreatitis to evaluate whether selective decontamination reduces mortality. SUMMARY BACKGROUND DATA:Secondary pancreatic infection is the major cause of death in patients with acute necrotizin...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Luiten EJ,Hop WC,Lange JF,Bruining HA

    更新日期:1995-07-01 00:00:00

  • Treatment of abdominal abscesses: comparative evaluation of operative drainage versus percutaneous catheter drainage guided by computed tomography or ultrasound.

    abstract::Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive thera...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Johnson WC,Gerzof SG,Robbins AH,Nabseth DC

    更新日期:1981-10-01 00:00:00

  • Multisource Evaluation of Surgeon Behavior Is Associated With Malpractice Claims.

    abstract:OBJECTIVE:We merged direct, multisource, and systematic assessments of surgeon behavior with malpractice claims, to analyze the relationship between surgeon 360-degree reviews and malpractice history. BACKGROUND:Previous work suggests that malpractice claims are associated with a poor physician-patient relationship, w...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Lagoo J,Berry WR,Miller K,Neal BJ,Sato L,Lillemoe KD,Doherty GM,Kasser JR,Chaikof EL,Gawande AA,Haynes AB

    更新日期:2019-07-01 00:00:00

  • Comparison of a lymph node ratio-based staging system with the 7th AJCC system for gastric cancer: analysis of 18,043 patients from the SEER database.

    abstract:OBJECTIVES:The American Joint Committee on Cancer (AJCC) staging system for gastric cancer bases N status on absolute number of metastatic nodes, regardless of the number of examined nodes. We examined a modified staging system utilizing node ratio (Nr), the ratio of metastatic to examined nodes. METHODS:A total of 18...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Wang J,Dang P,Raut CP,Pandalai PK,Maduekwe UN,Rattner DW,Lauwers GY,Yoon SS

    更新日期:2012-03-01 00:00:00

  • Pregnancy As a Risk Factor for Small Bowel Obstruction After Laparoscopic Gastric Bypass Surgery.

    abstract:OBJECTIVE:To evaluate whether pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery. BACKGROUND:Small bowel obstruction is a common and feared long-term complication to laparoscopic gastric bypass surgery that may be more common during pregnancy. It is unclea...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Stenberg E,Chen R,Hildén K,Fall K

    更新日期:2020-07-01 00:00:00

  • Molecules, cancer, and the surgeon. A review of molecular biology and its implications for surgical oncology.

    abstract::Interactions between molecules control intra- and intercellular physiology. Cancer is emerging as a disease in which individual molecules are either overproduced, mutated, expressed at inappropriate stages of development, or lost due to inheritance or aberrant mitotic division. The major players in this contest of cel...

    journal_title:Annals of surgery

    pub_type: 杂志文章,评审


    authors: Arbeit JM

    更新日期:1990-07-01 00:00:00

  • Glutathione protects the rat liver against reperfusion injury after prolonged warm ischemia.

    abstract:OBJECTIVE:To evaluate the potential of postischemic intravenous infusion of the endogenous antioxidant glutathione (GSH) to protect the liver from reperfusion injury following prolonged warm ischemia. BACKGROUND DATA:The release of reactive oxygen species (ROS) by activated Kupffer cells (KC) and leukocytes causes rep...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Schauer RJ,Gerbes AL,Vonier D,Meissner H,Michl P,Leiderer R,Schildberg FW,Messmer K,Bilzer M

    更新日期:2004-02-01 00:00:00

  • Should perioperative supplemental oxygen be routinely recommended for surgery patients? A Bayesian meta-analysis.

    abstract:OBJECTIVE:The purpose of this study is to use updated data and Bayesian methods to evaluate the effectiveness of hyperoxia to reduce surgical site infections (SSIs) and/or mortality in both colorectal and all surgery patients. Because few trials assessed potential harms of hyperoxia, hazards were not included. BACKGRO...

    journal_title:Annals of surgery

    pub_type: 杂志文章,meta分析


    authors: Kao LS,Millas SG,Pedroza C,Tyson JE,Lally KP

    更新日期:2012-12-01 00:00:00

  • The technique of laparoscopic cholecystectomy in children.

    abstract::Twelve children underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis during a 10-month period in one institution. The operative technique that has been described for adults was modified because of the smaller dimensions of pediatric patients. These modifications are discussed in this report, ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Davidoff AM,Branum GD,Murray EA,Chong WK,Ware RE,Kinney TR,Pappas TN,Meyers WC

    更新日期:1992-02-01 00:00:00

  • Twenty-five-year follow-up for liver resection: the personal series of Dr. Joseph G. Fortner.

    abstract:BACKGROUND:Liver resection is performed for many types of malignancies. Few reports document actual long-term survival. METHODS:Long-term follow-up of a series of 548 liver resections performed between 1970 and 1992 was performed and is presented. RESULTS:All patients were followed for at least 15 years after surgery...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Fortner JG,Fong Y

    更新日期:2009-12-01 00:00:00

  • Embryonic Origin of Primary Colon Cancer Predicts Pathologic Response and Survival in Patients Undergoing Resection for Colon Cancer Liver Metastases.

    abstract:BACKGROUND:The aim of this study was to determine the prognostic value of embryonic origin in patients undergoing resection after chemotherapy for colon cancer liver metastases (CCLM). METHODS:We identified 725 patients with primary colon cancer and known RAS mutation status who underwent hepatic resection after preop...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Yamashita S,Brudvik KW,Kopetz SE,Maru D,Clarke CN,Passot G,Conrad C,Chun YS,Aloia TA,Vauthey JN

    更新日期:2018-03-01 00:00:00

  • Hospital Volume of Antireflux Surgery in Relation to Endoscopic and Surgical Re-interventions.

    abstract:OBJECTIVE:To test the hypothesis that higher hospital volume decreases endoscopic and surgical re-intervention rates after antireflux surgery. BACKGROUND:Antireflux surgery for gastro-esophageal reflux disease is followed by varying rates of re-interventions. Whether hospital volume influences re-intervention rates is...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Markar S,Santoni G,Maret-Ouda J,Artama M,Färkkilä M,Lynge E,Pukkala E,Ness-Jensen E,von Euler-Chelpin M,Lagergren J

    更新日期:2020-01-06 00:00:00

  • Experimental subcapsular hematoma of the spleen: natural history and radioisotope scan correlation.

    abstract::An experimental model was developed in dogs to correlate radioisotope scan findings of iatrogenic, in vivo, splenic injury with the natural history of the injury as determined by the clinical course and both gross and microscopic observations. It was found that small subcapsular injuries do not appear as discrete foca...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Washburn ME,Balk MW,Mazat BA,Zurlo JA

    更新日期:1978-04-01 00:00:00

  • Impact of Weekday of Esophagectomy on Short-term and Long-term Oncological Outcomes: A Nationwide Population-based Cohort Study in the Netherlands.

    abstract:OBJECTIVE:The aim of this study was to determine whether weekday of esophagectomy impacts 30-day mortality, and short- and long-term oncologic outcomes in esophageal cancer. SUMMARY OF BACKGROUND DATA:Recent literature suggests a relationship between the weekday of esophagectomy and overall survival. This finding coul...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Visser E,van Rossum PSN,Verhoeven RHA,Ruurda JP,van Hillegersberg R

    更新日期:2017-07-01 00:00:00

  • Surgical management of primary hyperparathyroidism: the case for giving up quick intraoperative PTH assay in favor of routine PTH measurement the morning after.

    abstract:OBJECTIVE:To analyze the utility of quick intraoperative parathyroid hormone (PTH) measurement in the surgical management of primary hyperparathyroidism. BACKGROUND DATA:The use of intraoperative PTH monitoring is well established in the surgery of primary hyperparathyroidism. However, some false-negative predictions ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Mozzon M,Mortier PE,Jacob PM,Soudan B,Boersma AA,Proye CA

    更新日期:2004-12-01 00:00:00

  • Thrombotic thrombocytopenic purpura (TTP) and splenectomy: a current appraisal.

    abstract::Thrombotic thrombocytopenic purpura (TTP) is a disease process characterized by microangiopathic anemia, fever, neurologic manifestations, renal abnormalities, and thrombocytopenia. These clinical findings are caused by vascular occlusions of the microcirculation. At present the utilization of splenectomy, in the trea...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Rutkow IM

    更新日期:1978-11-01 00:00:00

  • Total pancreatectomy with preservation of the duodenum and pylorus for chronic pancreatitis.

    abstract::In an effort to minimize the nutritional complications that follow resection of the pancreas for severe chronic pancreatitis, the authors have performed a duodenum-preserving total pancreatectomy in eight patients for severe unremitting pain requiring large doses of opiate analgesia. Good relief of pain was obtained i...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Easter DW,Cuschieri A

    更新日期:1991-11-01 00:00:00

  • Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry.

    abstract:OBJECTIVE:To determine the incidence of anastomotic-related morbidity following Transanal Total Mesorectal Excision (TaTME) and identify independent risk factors for failure. BACKGROUND:Anastomotic leak and its sequelae are dreaded complications following gastrointestinal surgery. TaTME is a recent technique for recta...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究


    authors: Penna M,Hompes R,Arnold S,Wynn G,Austin R,Warusavitarne J,Moran B,Hanna GB,Mortensen NJ,Tekkis PP,International TaTME Registry Collaborative.

    更新日期:2019-04-01 00:00:00

  • A multivariate analysis of preoperative risk factors in patients with common bile duct stones. Implications for treatment.

    abstract::A multivariate analysis of 30 preoperative risk factors was undertaken in 248 patients who underwent surgery alone for common bile duct (CBD) stones and in 190 patients who had endoscopic sphincterotomy (ES), 77 of whom subsequently also had surgery. Independently significant risk factors in those undergoing surgery w...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Neoptolemos JP,Shaw DE,Carr-Locke DL

    更新日期:1989-02-01 00:00:00

  • Significant contribution of the portal vein to blood flow through the common bile duct.

    abstract:OBJECTIVE:The aim of this study was to determine the contribution of the hepatic artery, gastroduodenal artery, and portal vein to the microvascular blood flow in the common bile duct (CBD). BACKGROUND:Biliary complications are a common cause of graft loss after liver transplantation. The occurrence is, partly, attrib...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Slieker JC,Farid WR,van Eijck CH,Lange JF,van Bommel J,Metselaar HJ,de Jonge J,Kazemier G

    更新日期:2012-03-01 00:00:00

  • A Propensity-matched Analysis Comparing Survival After Esophagectomy Followed by Adjuvant Chemoradiation to Surgery Alone for Esophageal Squamous Cell Carcinoma.

    abstract:BACKGROUND:The role of adjuvant chemoradiation in esophageal cancer has been underestimated in the literature. This study was undertaken to determine whether adjuvant chemoradiation improves survival compared with surgery alone. METHODS:Data of 1095 esophageal squamous cell carcinoma (ESCC) patients, including 679 in ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Hwang JY,Chen HS,Hsu PK,Chao YK,Wang BY,Huang CS,Liu CC,Wu SC

    更新日期:2016-07-01 00:00:00