Abstract:
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.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Kelsall AC,Cassidy R,Ghaferi AAdoi
10.1097/SLA.0000000000002462subject
Has Abstractpub_date
2018-12-01 00:00:00pages
1014-1018issue
6eissn
0003-4932issn
1528-1140journal_volume
268pub_type
杂志文章abstract:OBJECTIVE:To assess the feasibility and safety of laparoscopic liver resections. SUMMARY BACKGROUND DATA:The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to conside...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200012000-00004
更新日期:2000-12-01 00:00:00
abstract::From 1963 through 1983, 327 patients underwent resection for gastric adenocarcinoma at Charity Hospital in New Orleans. Fifteen lesions (4.6%) were early gastric carcinoma (limited to the mucosa or submucosa regardless of nodal metastases). These lesions were in eight men and seven women (14 blacks and 1 white), with ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198608000-00001
更新日期:1986-08-01 00:00:00
abstract:OBJECTIVE:We hypothesized that inpatient postoperative pain trajectories are associated with 30-day inpatient readmission and emergency department (ED) visits. BACKGROUND:Surgical readmissions have few known modifiable predictors. Pain experienced by patients may reflect surgical complications and/or inadequate or dif...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002372
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:To assess whether regional intestinal oxygen saturation (rintSO2) and regional cerebral oxygen saturation (rcSO2) measurements aid in estimating survival of preterm infants after surgery for NEC. SUMMARY OF BACKGROUND DATA:Predicting survival after surgery for NEC is difficult yet of the utmost importance fo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003913
更新日期:2020-04-20 00:00:00
abstract::Obstructive cholangitis with acute renal failure is a dramatic syndrome which merits individual definition. Twenty-one patients with acute suppurative cholangitis complicated by rapidly developing renal insufficiency were studied, and the severity of the renal failure, an acute interstitial tubulopathy, bore no signif...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197506000-00022
更新日期:1975-06-01 00:00:00
abstract:OBJECTIVES:We examined the influence of surgeon age and other factors on proficiency in laparoscopic or open hernia repair. SUMMARY BACKGROUND DATA:In a multicenter, randomized trial comparing open and laparoscopic herniorrhaphies, conducted in Veterans Administration hospitals (CSP 456), we reported significant diffe...
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
doi:10.1097/01.sla.0000179644.02187.ea
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:To determine whether primary tumor resection in patients with metastatic pheochromocytoma or paraganglioma (PPG) is associated with longer overall survival (OS). BACKGROUND:Patients with metastatic PPG have poor survival outcomes. The impact of surgical resection of the primary tumor on OS is not known. MET...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002195
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to investigate the incidence of parastomal hernias (PSHs) after end-colostomy formation using a polypropylene mesh in a randomized controlled trial versus conventional colostomy formation. BACKGROUND:A PSH is the most frequent complication after stoma formation. Symptoms may range f...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000001903
更新日期:2017-04-01 00:00:00
abstract::Palliative exclusion of the esophagus by use of transposed stomach was performed in a 63-year-old woman with unresectable cervical esophageal cancer. Twelve weeks after this operation, motor function of the excluded esophagus was assessed. All voluntary swallows produced a motor response in the esophageal body. Eighty...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198712000-00017
更新日期:1987-12-01 00:00:00
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
doi:10.1097/SLA.0000000000002653
更新日期:2019-04-01 00:00:00
abstract::An analysis of 584 operations for recurrent inguinal hernia was made in an attempt to determine the cause of the recurrence based on the anatomic findings. The recurrence was indirect in 300, direct in 241, and various other in 43 operations. The causes of the indirect recurrences appeared to be an unrecognized hernia...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198512000-00019
更新日期:1985-12-01 00:00:00
abstract::The diagnosis of intra-abdominal abscess by radiographic means often relies on combining the results of several different imaging modalities. Computed tomography (CT) has been shown to be a safe, accurate and rapid diagnostic method of diagnosing these abscesses. Five patients with a variety of intra-abdominal abscess...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197901000-00006
更新日期:1979-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of herpes simplex viral (HSV) amplicon vectors for production of tumor vaccines and to determine if such vaccines expressing combinations of immunostimulatory agents may be effective in the treatment of experimental liver cancer. METHODS:A hepatic metastatic tumor model using CT-26 colore...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200209000-00010
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVE:To assess the role of registries in the postmarketing surveillance of surgical meshes. BACKGROUND:To date, surgical meshes are classified as group II medical devices. Class II devices do not require premarket clearance by clinical studies. Ethicon initiated a voluntary market withdrawal of Physiomesh for lap...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002326
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:Because of rising costs and shrinking reimbursements, hospitals must continually find ways to improve efficiency and productivity. This study attempts to increase caseloads in ambulatory surgery operating rooms while maintaining patient satisfaction and safety. SUMMARY BACKGROUND DATA:In most hospitals, pati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000193600.97748.b1
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To assess the accuracy of physical examination, ultrasonography, and mammography in predicting residual size of breast tumors following neoadjuvant chemotherapy. BACKGROUND:Neoadjuvant chemotherapy is an accepted part of the management of stage II and III breast cancer. Accurate prediction of residual pathol...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000197714.14318.6f
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:This study aims at improving diagnosis of intestinal ischemia, by measuring plasma and urinary fatty acid binding protein (FABP) levels. METHODS:Fifty consecutive patients suspected of intestinal ischemia were included and blood and urine were sampled at time of suspicion. Plasma and urinary concentrations o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318207a767
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess how thermal ablation of colorectal liver metastases affects the outgrowth of micrometastases in the transition zone (TZ) between ablated tissue and the unaffected reference zone (RZ) in 2 different murine models. BACKGROUND:Thermal destruction therapies of nonresectable co...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181a38ef5
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the role of surgical transgastric necrosectomy (TGN) for walled-off pancreatic necrosis (WON) in selected patients. BACKGROUND:WON is a common consequence of severe pancreatitis and typically occurs 3 to 5 weeks after the onset of acute pancreatitis. When symptomatic, it...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000003048
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To compare surgical versus medical treatment of type 2 diabetes mellitus (T2DM) remission and comorbidities in patients with a body mass index (BMI) less than 35 kg/m2. BACKGROUND:Obesity surgery can achieve remission of T2DM and its comorbidities. Metabolic surgery has been proposed as a treatment option fo...
journal_title:Annals of surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1097/SLA.0000000000001014
更新日期:2015-03-01 00:00:00
abstract:OBJECTIVE:To investigate long-term outcomes of locally advanced rectal cancer (LARC) patients with postchemoradiotherapy (post-CRT) pathologic complete response of primary tumor (ypT0) and determine prognostic significance of post-CRT pathologic nodal (ypN) status. BACKGROUND:LARC patients with post-CRT pathologic com...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181f3f1b1
更新日期:2010-12-01 00:00:00
abstract::Two hundred thirty-four patients with extensive ulcerative colitis from the city of Göteborg, Sweden have been followed up and the cumulative risk of development of cancer of the large bowel was estimated. These patients constitute all persons in this region who developed an extensive ulcerative colitis between 1951 a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197812000-00018
更新日期:1978-12-01 00:00:00
abstract:OBJECTIVE:To assess ischemia and reperfusion (I/R) injury in a hemihepatectomy model in pigs after prolonged continuous or intermittent vascular inflow occlusion in the liver. SUMMARY BACKGROUND DATA:Massive intraoperative blood loss during liver resections can be prevented by temporary vascular inflow occlusion, cons...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199903000-00011
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:To determine prevalence of documented preoperative code status discussions and post-operative outcomes (specifically mortality, readmission and discharge disposition) of patients with completed Medical Orders for Life-Sustaining Treatments (MOLST) forms before surgery. SUMMARY OF BACKGROUND DATA:A MOLST form...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004675
更新日期:2020-12-18 00:00:00
abstract::The combined Cambridge/King's College Hospital series of 64 orthotopic liver grafts' experience dates back to 1968. Many patients were referred for liver grafting late in the course of their diseases and were operated on when they were too ill or died before suitable livers could be found. Complications of biliary dra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197709000-00006
更新日期:1977-09-01 00:00:00
abstract:OBJECTIVE:The results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction were evaluated. SUMMARY BACKGROUND DATA:Extrahepatic portal venous obstruction, a common cause of portal hypertension in children in India, is being treated increasingly by endoscopic sclerotherapy instead...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199402000-00011
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVES:To clarify whether bowel preparation use or its individual components [mechanical bowel preparation (MBP)/oral antibiotics] impact specific outcomes after colorectal surgery. METHODS:National Surgical Quality Improvement Program-targeted colectomy data initiated in 2012 capture information on the use/type o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001416
更新日期:2015-09-01 00:00:00
abstract::Study A included 30 patients who received immediate postoperative enteral feeding with a nonelemental diet. The nonelemental diet was well tolerated. Study patients rapidly achieved nitrogen equilibrium and had a cumulative nitrogen balance of -11.1 g verus -46.7 g for the control group. In part B, 16 patients with va...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198011000-00003
更新日期:1980-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. BACKGROUND:Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of surgery can lead to ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e3181fd36a2
更新日期:2010-11-01 00:00:00
abstract::The role of surgery in the treatment of gastrinoma is unclear. The purpose of this study was to determine prospectively the surgical cure rate using a controlled clinical trial. Eleven patients who fit the entry criteria underwent abdominal exploration and attempted tumor resection for cure. A historical control group...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199001000-00002
更新日期:1990-01-01 00:00:00