Insurance status influences weight loss and complication rates following bariatric surgery.

Linden A Karas, MD1, Madhu Siddeswarappa, MD1, Stephen D Slane, PhD2, Prashanth Ramachandra, MD1. 1Mercy Catholic Medical Center, 2Cleveland State University

Background: Insurance status has often been used as a marker of socioeconomic status since private insurance typically implies employment or private income. Martin et al (June, 1991) found that private insurance was linked to fewer post-operative medical and psychiatric complications following bariatric surgery. However, in that group’s comparison, weight loss outcomes were similar between patients with private and publicly funded insurance. This study sought to determine if insurance status impacts weight loss outcomes and complication rates in a cohort of bariatric surgery patients.

Methods: A retrospective chart review was performed of all patients who underwent bariatric procedures by two surgeons at a community hospital Bariatric Center of Excellence in Philadelphia, PA. Surgeries included laparoscopic and open gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and revisional procedures occurring between February 2012 and April 2014. Demographic information, type of insurance, number and type of medical co-morbidity, duration of anesthesia, length of hospital stay (LOS), post-operative complications, and initial weight and BMI as well as percent excess weight loss (% EWL) at three, six, nine, 12, and 18 months were obtained. Statistical analysis was performed using Student’s T-test.

Results: Of 402 total patients, 163 carried private insurance and 239 carried publicly funded insurance. Duration of anesthesia was significantly longer (t=3.7, p=0.00) and patient age was significantly older (t=2.823, p=0.005), while LOS was not significantly different (t=0.52, p=0.6) in patients with public insurance compared with private. Publicly insured patients also had a greater number of baseline co-morbid medical conditions (t=8.17, p=0.001) than those with private insurance. Patients with publicly funded health insurance had significantly less weight loss at three months post-operatively (t=-2.549, p = 0.011) through 18 months post-operatively (t=-3.138, p=0.002) when measured as %EWL. Initial (t=2.305, p=0.022) and post-operative BMI were also significantly greater in patients with publicly funded insurance (t=3.061, p=0.002 at 18 months). Also, complication rates were significantly greater in the group with public insurance (t=2.957, p=0.003).

Conclusion: Preoperative insurance status may influence weight loss outcomes and complication rates following bariatric surgery. This study suggests that the patients who carry private insurance lose more weight and have fewer complications postoperatively when compared to patients who have publicly funded insurance. However, this publicly insured population tended to be older, have more co-morbidities and longer surgery times that those with private insurance. This data introduces the concern that socioeconomic status may affect weight loss outcomes and complication rates after bariatric surgery.

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