Value Analysis of Improving Diabetes and Obesity on Total Episode Payment Outcomes after Common Surgical Procedures

Document Type

Conference Proceeding

Publication Date

11-1-2023

Publication Title

J Am Coll Surg

Abstract

Introduction: Total episode payments across surgical episodes of care provide healthcare systems with information on ways to reduce costs and optimize value when treating certain conditions. Although obesity and type 2 diabetes (T2D) are often associated with perioperative complications, the impact on total episode payments for common surgical procedures remains unclear. Methods: The analysis included 90-day claims-based episodes of care for patients who underwent surgery between 1/1/2015 and 12/31/2021 for non-cancer colectomy, abdominal/groin hernia repair, hysterectomy, or total knee or hip replacement (total n=235,324). Patients with a diagnosis of obesity and T2D (n=20,510) were compared with patients without either diagnosis (N=214,814). Measures including 90-day price-standardized total episode payments, readmission payments, emergency room (ER) payments, and surgery length of stay (LOS) were calculated. Results: Patients with obesity and T2D had higher price-standardized 90-day total episode payments than the comparison group, regardless of procedure type. Obesity and T2D were also associated with significantly longer LOS, as well as higher rates of ER visits and readmissions (Figure 1). The impact of diabetes and obesity was greatest with hernia repair, with a total episode payment difference of $9,553. Hernia repair also had the largest between-group differences in rates of readmissions and ER visits, which were 8.7% and 6.6%, respectively. Conclusion: Obesity and diabetes has a significant impact on total episode payment costs for common surgical procedures and doubles the cost of hernia repair. Maximizing weight loss and inducing diabetes remission through intensive focused efforts, including metabolic surgery, should be considered before elective procedures.

Volume

237

Issue

5

First Page

S186-S187

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