Insurance Status and Outcomes in Laparoscopic Adjustable Gastric Banding

Balash, Paul R.; Wilson, Nicole A.; Bruns, Nicholas E.; Luu, Minh B.; Francescatti, Amanda B.; Maroulis, Basile; Autajay, Khristi; Myers, Jonathan A.

doi:10.1097/sle.0b013e31829cec47

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Unfortunately, in a retrospective study of patients having RYGB by Jensen-Otsu et al (357), patients with Medicaid coverage, in aggregate, had longer lengths of hospital stays and higher hospital readmission rates within 30 days of discharge, compared with those having commercial insurance coverage. On the other hand, among patients having LAGB, there was no difference in postoperative weight loss between those paying out-of-pocket and those covered by private insurance (358). An assessment on the cost evaluation in patients receiving Medicare reimbursements demonstrated significantly lower payments at hospitals with low complication rates (359).…”

Section: R5 (2019*)mentioning

confidence: 98%

Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

et al. 2019

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Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusion: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues. Abbreviations: A1C = hemoglobin A1c; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; ACE = American College of Endocrinology; ADA = American Diabetes Association; AHI = Apnea-Hypopnea Index; ASA = American Society of Anesthesiologists; ASMBS = American Society of Metabolic and Bariatric Surgery; BMI = body mass index; BPD = biliopancreatic diversion; BPD/DS = biliopancreatic diversion with duodenal switch; CI = confidence interval; CPAP = continuous positive airway pressure; CPG = clinical practice guideline; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; DBCD = dysglycemia-based chronic disease; DS = duodenal switch; DVT = deep venous thrombosis; DXA = dual-energy X-ray absorptiometry; EFA = essential fatty acid; EL = evidence level; EN = enteral nutrition; ERABS = enhanced recovery after bariatric surgery; FDA = U.S. Food and Drug Administration; G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GERD = gastroesophageal reflux disease; GI = gastrointestinal; HCP = health-care professional(s); HTN = hypertension; ICU = intensive care unit; IGB = intragastric balloon(s); IV = intravenous; LAGB = laparoscopic adjustable gastric band; LAGBP = laparoscopic adjustable gastric banded plication; LGP = laparoscopic greater curvature (gastric) plication; LRYGB = laparoscopic Roux-en-Y gastric bypass; LSG = laparoscopic sleeve gastrectomy; MetS = metabolic syndrome; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; OAGB = one-anastomosis gastric bypass; OMA = Obesity Medicine Association; OR = odds ratio; ORC = obesity-related complication(s); OSA = obstructive sleep apnea; PE = pulmonary embolism; PN = parenteral nutrition; PRM = pulmonary recruitment maneuver; RCT = randomized controlled trial; RD = registered dietician; RDA = recommended daily allowance; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; SIBO = small intestinal bacterial overgrowth; TOS = The Obesity Society; TSH = thyroid-stimulating hormone; T1D = type 1 diabetes; T2D = type 2 diabetes; VTE = venous thromboembolism; WE = Wernicke encephalopathy; WHO = World Health Organization

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Section: R5 (2019*)mentioning

confidence: 98%

Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

et al. 2019

View full text Add to dashboard Cite

show abstract

“…On the other hand, among patients having LAGB, there was no difference in postoperative weight loss between those paying out‐of‐pocket and those covered by private insurance . An assessment on the cost evaluation in patients receiving Medicare reimbursements demonstrated significantly lower payments at hospitals with low complication rates . With increased variation in hospital episode payments, bundled payment programs are being considered for bariatric procedures .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

340

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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“…Our review of the literature reveals that these variations in outcomes following ORYGB have, to our knowledge, not been reported previously and are important findings of this study. This advance knowledge can forewarn surgeons of possible results and post-ORYGB problems that may facilitate optimal treatment of these fragile patients.…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative and observational studies are insufficient to explore the complex function and behaviors of operative teams. Although qualitative evaluations of surgical care exist, 5,6 to our knowledge, there has been minimal investigation of clinicians' perceptions on topics of operative team identity, management of operative team member unfamiliarity, and intraoperative hand-offs. Engaging stakeholders and evaluating their perspectives is critical to setting an agenda for further investigation and the design and implementation of best practice guidelines or team training interventions.…”

Section: Concept and Designmentioning

confidence: 99%

Variation in Weight and Obesity Comorbidities After Open Roux-en-Y Gastric Bypass by Health Insurance

et al. 2017

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Open Roux-en-Y gastric bypass (ORYGB) is performed primarily on patients with complicated intra-abdominal pathology, massive obesity not conducive to laparoscopy, or prohibitive medical conditions. Gomez et al 1 reported significant variation in weight loss and resolution of medical problems in superobese patients after biliopancreatic diversion/duodenal switch. However, to our knowledge, whether health insurance status similarly influences the results of patients undergoing ORYGB is unknown. Therefore, the objective of this study was to identify variation in ORYGB outcomes by health insurance status.

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Insurance Status and Outcomes in Laparoscopic Adjustable Gastric Banding

Cited by 6 publications

References 16 publications

Variation in Weight and Obesity Comorbidities After Open Roux-en-Y Gastric Bypass by Health Insurance

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