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A Cost Analysis of Healthcare Episodes Including Day-Case Bariatric Surgery (Roux-en-Y Gastric Bypass and Sleeve Gastrectomy) Versus Inpatient Surgery

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Abstract

Background

Assessing the medico-economic outcomes of a healthcare pathway including day-case bariatric surgery versus the conventional pathway.

Methods

This economical evaluation is a prospective cohort study with historical controls. Between March 2019 and December 2020, 30 patients eligible for bariatric surgery were considered in the day-case group. Surgical procedures included sleeve gastrectomy and Roux-en-Y gastric bypass. The day-case pathway included patient education, post-discharge follow-up by a community nurse twice-daily and standardized communications to surgeons. Day-case patients were paired with 30 inpatients, based on the type of intervention, age, and ASA status. The primary outcome was the cost of care episodes from the preoperative visit to the 30-day postoperative visit. Micro-costing methodology and activity-based costing were used. Secondary outcomes included length of hospital stay, rate of unanticipated events, and patient’ satisfaction assessment.

Results

Male-to-female ratio was 1/2. In the day-case versus inpatient group, age, number of associated medical conditions, and BMI (42.9 ± 4.9 versus 42.6 ± 4.6, p > 0.05) were similar. In the day-case group, there were 7 overnight stays (23.3%), 3 readmissions (10%), and 4 unscheduled consultations (13.3%). The overall length of hospital stay was significantly shorter (0.65 ± 0.33, versus 2.9 ± 0.4 days, p < 0.0001). The complication rate was 6.6% in both groups. The cost of the care episode was € 4272.9 ± 589.7 for the day-case group versus € 4993.7 ± 695.6 for inpatients, corresponding to a 14.4% cost reduction (p = 0.0254).

Conclusions

Day-case bariatric surgery appears to be safe and beneficial in terms of costs. It involves a specific organization with postdischarge follow-up.

Trial Registration

ClinicalTrial.gov: NCT04423575.

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Acknowledgements

The authors would like to acknowledge that this project was conducted in partnership with Medtronic Integrated Health Solutions, as a part of Fast Path Medtronic & IHU project. The authors would like to thank to Armelle Takeda and Myriam Bencherif for their data collection and research assistance. The authors would also like to thank Guy Temporal, Sarah Mitchel and Christopher Burel for their English editing and proofreading.

Author information

Author notes

  1. Ignat and Ansiaux have contributed equally to this work.

Authors and Affiliations

  1. Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1 place de l’Hôpital, 67091, Strasbourg, France

    Mihaela Ignat, Julien Ansiaux, Samah Osailan, Antonio D’Urso, Michel Vix & Didier Mutter

  2. IRCAD/IHU: Institute of Image-Guided Surgery, 1 place de l’Hôpital, 67091, Strasbourg, France

    Mihaela Ignat, Antonio D’Urso, Michel Vix & Didier Mutter

  3. Department of Digestive Surgery, CHICAS Gap, 1 place Auguste Muret, 05000, Gap, France

    Mihaela Ignat & Julien Ansiaux

  4. Medtronic France IHS, Bâtiment IHU, 1 Place de l’Hôpital, 67000, Strasbourg, France

    Linda Morainvillers-Sigwalt

Authors
  1. Mihaela Ignat
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  2. Julien Ansiaux
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  3. Samah Osailan
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  4. Antonio D’Urso
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  5. Linda Morainvillers-Sigwalt
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  6. Michel Vix
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  7. Didier Mutter
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Corresponding author

Correspondence to Mihaela Ignat.

Ethics declarations

Ethics Approval

All procedures performed in this study were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in this study.

Conflict of Interest

The authors declare no competing interests.

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Key Points

• An integrated healthcare pathway for day-case bariatric surgery was formalized.

• Healthcare episodes of 30 day-case patients were compared to controls.

• The day-case pathway resulted in a significant cost reduction (14.4%).

• Morbidity was 6.6% in both groups.

Supplementary Information

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Supplementary file1 (DOCX 29 KB)

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Ignat, M., Ansiaux, J., Osailan, S. et al. A Cost Analysis of Healthcare Episodes Including Day-Case Bariatric Surgery (Roux-en-Y Gastric Bypass and Sleeve Gastrectomy) Versus Inpatient Surgery. OBES SURG 32, 2504–2511 (2022). https://doi.org/10.1007/s11695-022-06144-3

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  • DOI: https://doi.org/10.1007/s11695-022-06144-3

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