A Longitudinal Analysis of Short-Term Costs and Outcomes in a Regionalized Center of Excellence Bariatric Care System
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BACKGROUND: Evaluating how morbidity and costs evolve for new bariatric centers is vital to understanding the expected length of time required to reach optimal outcomes and cost efficiencies. Accordingly, the objective of this study was to evaluate how morbidity and costs changed longitudinally during the first 5 years of a regionalized center of excellence system. METHODS: This was a longitudinal analysis of the first 5 years of a bariatric center of excellence system. The main outcomes of interest were all-cause morbidity and cost for the index admission. Predictors of interest included patient demographics, comorbidities, annual hospital and surgeon volume, fellowship teaching center status, and year of procedure. Hierarchical regression models were used to determine predictors of morbidity and costs. RESULTS: Procedures done in 2012 (OR 0.65, 95%CI 0.52-0.79; p < 0.001), 2013 (OR 0.63, 95%CI 0.51-0.78; p < 0.001), and 2014 (OR 0.53, 95%CI 0.43-0.65; p < 0.001) all conferred a significantly lower odds of morbidity when compared to the initial 2009/2010 years. Surgeon volume was associated with a decreased odds of morbidity as for each increase in 25 bariatric cases per year the odds of all-cause morbidity was 0.94 lower (95%CI 0.88-1.00; p = 0.04). There was no significant variation at the hospital or surgeon level in perioperative outcomes. CONCLUSION: This study determined that volume was important even for high resource, fellowship-trained surgeons. It also found a decrease in morbidity over time for new centers. Lastly, there was little variation in outcomes across hospitals and surgeons suggesting that strict accreditation standards can help to ensure high quality across hospital sites.
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