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Operative Costs of Bariatric Surgery

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Introduction

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Obesity is a worldwide epidemic. In the United States alone, not only are the majority of adult Americans overweight, but approximately 30% of its citizens are affected by morbid obesity. The resultant increase in bariatric surgical procedures mandates examination of operative costs of this surgery. Our group analyzed, for the US Southwest region, the cost of the two most common procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic adjustable gastric band (LAGB). Operative cost categories included the following costs:

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  1. Anesthesia professional costs, defined as charges rendered by an anesthesiologist or certified registered nurse anesthetist according to the guidelines of the American Society of Anesthesiologists (ASA).

  2. Operating room costs, defined as nonprofessional anesthesia and operating room utilization fees.

  3. Instrument costs, which included two subcategories, disposable items and reusable items.

  4. Hospital costs.

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Results

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Anesthesia Professional Costs
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The relative value guide booklet issued by the ASA recognizes LRYGBP and LAGB as one and the same. A unit is a $70 charge. For each case, an initial 10-unit charge is rendered. After the first scalpel cut occurs, every 15 minutes yields a 1-unit charge; thus, each hour of surgery costs 4 units. An LAGB that takes an average of 2.5 hours is charged 20 units or $1400; the LRYGBP that takes an average of 3 hours incurs a $1540 charge. In addition, more units are added to the case depending on the complexity of the patient's management, which is at the discretion of the anesthesiologist. Anesthesia time ends when the patient is signed out to the nursing team in the postanesthesia recovery room.1

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Operating Room Costs, Reimbursement of Bariatric Costs

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Operating Room Costs
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  • LRYGBP. An LRYGBP that takes 3 hours is charged as follows. OR fees for anesthesia equipment is $454 per hour. LRYGBP is a complexity level 4 laparoscopic procedure, the room utilization fee of which is $4485 for the first hour and $767 for each additional half hour. The OR room cost is 3× $454 + 1 × $4485 + 4 × $767 = $8915.
  • LAGB. Like LRYGBP, LAGB is also charged on hourly basis. If the LAGB takes 2.5 hours, the total OR fees would be 2.5 × $454 + 1× $4485 + 3× $767 = $7921.

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Tables 47–1, 47–2, and 47–3 delineate actual instrument costs. The aforementioned examples are instructive, but Table 47–4 should be specifically referenced, as it reflects average actual OR charges and anesthesia charges for the two procedures.

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Table Graphic Jump Location
Table 47–1. Reusable Instruments Costs, to Be Used in Both Operations 

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