Quantifying Healthcare Utilization and Delay in the Treatment of Gastric Stenosis Following Sleeve Gastrectomy

摘要

Background Sleeve gastrectomy (SG) is the most common bariatric procedure performed. The incidence of gastric sleeve stenosis (GSS) is up to 4%, with a rising prevalence given increasing popularity of this surgery. GSS is best treated with pneumatic balloon dilation (PBD), but the diagnosis is not always straightforward, oftentimes leading to an extensive diagnostic workup. The aims of the current study were to quantify delay to treatment and overall healthcare utilization during this delay in patients with GSS following SG. Methods This was a retrospective review of a prospectively collected database including patients with SG diagnosed with GSS between October 2017 and September 2020. The primary outcome was time between symptom development and treatment with PBD. Secondary outcomes included total healthcare utilization as reflected by the number and charges of imaging and emergency room (ER) visits. Results Forty-five patients were included in the analysis; 37 (82%) were female. The mean (+/- SD) time to treatment was 755 (+/- 713) days. The probability of receiving treatment at 1, 2, and 3 years was 37%, 62%, and 76%, respectively. The mean (+/- SD) abdominal CT scans, radiographs, and UGIS between symptoms and PBD were 1.3 +/- 2.0, 1.2 +/- 1.6, and 1.2 +/- 1.0, respectively. The mean number of ER visits was 1.9 +/- 2.5 (range 0-8). The average number of diagnostic non-therapeutic upper endoscopies was 1.6 +/- 1.5. The mean (+/- SD) total charges were $16,473 +/- 15,173. Conclusion Patients who develop GSS following SG experience significant delay in diagnosis and management, reflected by multiple imaging studies, emergency department visits, and non-therapeutic procedures.