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The value of surgical experience: excess costs associated with the Roux-en-Y gastric bypass learning curve

  • 2018 SAGES Oral
  • Published:
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Abstract

Background

Gastric bypass has a steep learning curve that is associated with increased adverse outcomes and these adverse outcomes are associated with increases in cost. This study sought to quantify the effect of cumulative procedure volume on inpatient cost and characterize the excess cost associated with a surgeon’s learning curve.

Methods

This was a retrospective study of 29 high-volume surgeons during the first 6 years of performing gastric bypass in a regionalized center of excellence system. Cumulative volume was determined using the procedure date and analyzed in blocks of 25 cases. The main outcomes of interest were inpatient cost for the initial hospital stay in 2014 Canadian dollars as well as prolonged length of stay (≥ 3 days).

Results

Overall, 11,684 cases were identified from April 2009 to March 2015. After a surgeon’s 50th case, the adjusted inpatient cost decreased by $2775 (95% CI $− 4352 to $− 1204 p = 0.001) compared to the first 25 cases. Cost savings were maintained through a surgeon’s 400th case. The average cost savings after the 50th case was $2082 (95% CI $− 3194 to $− 962 p < 0.001) and the excess cost attributable to the first 50 cases was $104,077 (95% CI 48,104 to 159,682) per surgeon. Surgeon experience was also associated with a decrease odds of prolonged length of stay.

Conclusions

This study demonstrated the influence of surgeon experience on improved cost efficiencies. We also characterized that the average excess cost per surgeon of implementing gastric bypass was approximately $104,000. This is relevant to future health system planning as well as providing an economic incentive for impactful training interventions.

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Authors and Affiliations

  1. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Aristithes G. Doumouras, Scott Gmora, Mehran Anvari & Dennis Hong

  2. Division of General Surgery, St. Joseph’s Healthcare, Hamilton, ON, Canada

    Aristithes G. Doumouras, Fady Saleh, Scott Gmora, Mehran Anvari & Dennis Hong

  3. Division of General Surgery, St. Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Dennis Hong

Authors
  1. Aristithes G. Doumouras
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  2. Fady Saleh
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  3. Scott Gmora
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  4. Mehran Anvari
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  5. Dennis Hong
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Corresponding author

Correspondence to Dennis Hong.

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Disclosures

Drs. Doumouras, Saleh, Gmora, Anvari, and Hong have no conflicts of interest or financial ties to disclose.

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Doumouras, A.G., Saleh, F., Gmora, S. et al. The value of surgical experience: excess costs associated with the Roux-en-Y gastric bypass learning curve. Surg Endosc 33, 1944–1951 (2019). https://doi.org/10.1007/s00464-018-6472-x

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  • DOI: https://doi.org/10.1007/s00464-018-6472-x

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