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Quality Improvement in Bariatric Surgery: The Impact of Reducing Postoperative Complications on Medicare Payments

Fry, Brian, T., MS*,†; Scally, Christopher, P., MD*,‡,§; Thumma, Jyothi, R., MPH*; Dimick, Justin, B., MD, MPH*,‡

doi: 10.1097/SLA.0000000000002613
Original Article: PDF Only

Objective: To determine the temporal relationship between reducing surgical complications and costs, using the study population of bariatric surgery.

Background: Understanding the relationship between quality and costs has significant implications for the business case of investing in performance improvement. An unprecedented focus on safety in bariatric surgery has led to substantial reductions in complication rates over time, making it an ideal patient population in which to examine this relationship.

Methods: We performed a retrospective review of Medicare beneficiaries undergoing bariatric surgery in the years 2005 to 2006 and 2013 to 2014 (total N = 37,329 patients, 562 hospitals). Hospitals were ranked into quintiles based on their degree of improvement in risk and reliability-adjusted 30-day rates of serious complications across the time periods. Multivariable regression was used to calculate corresponding changes in average price-standardized payments for each quintile of hospitals.

Results: We found a strong association between reductions in complications and decreased Medicare payments. The top 20% of hospitals had a decrease in average serious complication rate of 7.3% (10.0%–2.7%; P < 0.001) and an average per-patient savings of $4861 (95% confidence interval $3921–5802). Conversely, the bottom 20% of hospitals had smaller decrease in complication rate of 0.8% (4.4% to 3.6%; P < 0.001) and a smaller average savings of $2814 (95% confidence interval $2139–3490).

Conclusions: When analyzing Medicare patients undergoing bariatric surgery, hospitals with the largest reductions in serious postoperative complications had the greatest decrease in per-patient payments. This study demonstrates the potential savings associated with quality improvement in high-risk surgical procedures.

*University of Michigan Center for Healthcare Outcomes and Policy, Ann Arbor, MI

University of Michigan Medical School, Ann Arbor, MI

University of Michigan Department of Surgery, Ann Arbor, MI

§University of Texas MD Anderson Department of Surgical Oncology, Houston, TX.

Reprints: Brian T. Fry, MS, Center for Healthcare Outcomes & Policy, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109. E-mail:

Funding: This study was supported by grant R01AG039434 to J.B.D. from the National Institute on Aging. B.T.F. is supported by National Institutes of Health grant 1TL1TR002242 through the Master of Science in Clinical Research program at the University of Michigan. The views expressed herein do not necessarily represent the views of the United States Government. J.R.T and B.T.F had access to all of the data in this study and take full responsibility for the integrity of the data, and also the accuracy of the data analysis.

Conflicts of interest: J.B.D. is a consultant and has an equity interest in ArborMetrix, Inc, which provides software and analytics for measuring hospital quality and efficiency. The company had no role in the study herein. There are no other potential conflicts of interest to disclose.

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