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Original Investigation
May 17, 2017

Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery

Author Affiliations
  • 1Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
  • 2Surgical Innovation Editor, JAMA Surgery
JAMA Surg. Published online May 17, 2017. doi:10.1001/jamasurg.2017.1093
Key Points

Question  How often does device-related reoperation occur after laparoscopic gastric band surgery and what are the associated expenditures for payers?

Findings  In this study of 25 042 Medicare beneficiaries who had the gastric band placed between 2006 and 2013, 4636 patients (18.5%) underwent 17 539 reoperations (an average of 3.8 procedures/patient). During the study period, Medicare paid $470 million for laparoscopic gastric band–associated procedures, of which $224 million (47.6%) of the payments were for reoperations.

Meaning  Reoperations after a gastric band placement are common and costly and raise concern about the safety, effectiveness, and value of the device.

Abstract

Importance  Following the US Food and Drug Administration approval for laparoscopic gastric band surgery in 2001, as many as 96 000 devices have been placed annually. The reported rates of reoperation range from 4% to 60% in short-term studies; however, to our knowledge, few long-term population-level data on outcomes or expenditures are known.

Objective  To describe the rate of device-related reoperations occurring after laparoscopic gastric band surgery as well as the associated payments in a longitudinal national cohort.

Design, Settings, and Participants  This retrospective review of 25 042 Medicare beneficiaries who underwent gastric band placement between 2006 and 2013 identifies gastric band–related reoperations, including device removal, device replacement, or revision to a different bariatric procedure (eg, a gastric bypass or sleeve gastrectomy). The rates of reoperation were risk adjusted using a multivariable logistic regression model that included patient age, sex, race/ethnicity, Elixhauser comorbidities, and the year that the operation was performed.

Main Outcomes and Measures  Rate of device-related reoperation nationally and across individual hospital referral regions. Thirty-day total episode Medicare payments to hospitals for the index operation and any subsequent reoperations.

Results  Of the 25 042 patients who underwent gastric band placement, 20 687 (82.61%) were white, 18 143 (72.45%) were women, and the mean age was 57.56 years. Patients (mean age, 57.5; 76.2% women) requiring reoperation had lower rates of hypertension (64.9% vs 73.4%; P < .001) and diabetes (40.4% vs 44.6%; P < .001) and were more likely to have their index operation at a for-profit hospital (34.6% vs 22.0%; P < .001). With an average of 4.5-year follow-up, 4636 patients (18.5%) underwent 17 539 reoperations (an average of 3.8 procedures/patient). Hospital referral regions demonstrated a 2.9-fold variation in risk- and reliability-adjusted rates of reoperation (lower quartile average, 13.3%; upper quartile average, 39.1%). During the study period, Medicare paid $470 million for laparoscopic gastric band associated procedures, of which $224 million (47.6%) of the payments were for reoperations. From 2006 to 2013, the proportion of payments from Medicare for reoperations increased from 16.4% to 77.3% of their annual spending on the gastric band device.

Conclusions and Relevance  Among Medicare beneficiaries undergoing gastric band surgery, device-related reoperation was common, costly, and varied widely across hospital referral regions. These findings suggest that payers should reconsider their coverage of the gastric band device.

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