Background

Laparoscopic gastric banding (LAGB) was historically among the most performed bariatric procedures but has fallen out of favor in recent years due to poor long-term weight loss and high revisional surgery rates. Significant financial hardship of medical care, known as “financial toxicity”, can occur from experiencing unexpected complications of LAGB. We investigated the risk of financial toxicity among patients being admitted for LAGB complications.

Methods

All uninsured and privately insured patients who were admitted for LAGB complications were identified from the National Inpatient Sample 2015-2019. Publicly available government data (US Census Bureau, Bureau of Labor, The Centers for Medicare and Medicaid Services) were utilized to estimate patient income, food expenditures, and average maximum out-of-pocket expenditures. Financial toxicity was defined as total admission cost from LAGB complications >40% of post-subsistence income.

Results

Among 28,005 patients, 66% patients had private insurance and 44% patients were uninsured. Median total admission cost was $12,443 (IQR $7,959-$19,859) and $15,182 for those who received revisional bariatric surgery. Approximately 55% of the uninsured patients and 1% of insured patients were at risk of financial toxicity after admission for banding-related complications. Patients who had an emergency admission, revisional surgery, or post-operative ICU admission were more likely to experience financial catastrophe following admission (P<0.01).

Conclusions

About 1 in 2 uninsured patients who are admitted for LAGB-related complications were at risk of financial toxicity. In addition to surgical risks, providers should consider the potential financial consequences of LAGB when counseling patients on their choice of surgery.