Outcomes of bariatric surgery in patients of lower socioeconomic status versus patients of higher socioeconomic status

Aaron Purser1, Angel Farinas, MD2, Christian Cruz, MD2, Angelina Postoev2, Christopher Ibikunle, MD2, Aliu Sanni, MD2. 1GRU/UGA Medical Partnership, 2Georgia Surgicare

INTRODUCTION: Patients who undergo bariatric surgery are disproportionately middle aged white women with private insurance. Previous data has shown that those who have publicly funded insurance (Medicare/ Medicaid) or are described in a low socioeconomic class have decreased access for surgery. While this disparity has been established, there has been a lack of research analyzing the outcomes of bariatric surgery in patients who have publicly funded insurance/low socioeconomic class compared to those using commercial/private insurance/high socioeconomic class. This study was designed to address this concern.

METHODS: A systematic review was conducted through PubMed to identify relevant studies with comparative data on bariatric patients who represent lower socioeconomic classes compared to those in higher socioeconomic classes. Selection criteria was based on socioeconomic status, median household annual income, and primary insurance carrier. The primary outcome was mortality. Secondary outcomes addressed weight loss (or decrease in BMI), mean length of stay in the hospital, postoperative comorbidities, and availability to follow-up. Results are expressed as standard difference in means with standard error. Statistical analysis was done using fixed-effects meta-analysis to compare the mean value of the separate groups (Comprehensive Meta Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).

RESULTS: Four out of 64 studies identified were quantitatively assessed and included for meta-analysis. This data included three retrospective studies and 1 prospective study. Among the four studies, 295 patients were specifically identified as socioeconomically deprived or dependent on Medicaid/Medicare, 47 patients were listed as self-financed, and 905 were privately/commercially insured. The postoperative mortality rate was found to be higher in the publicly funded group (4.8% vs. 0.8%, p<0.007) when compared to the private/commercial insurance group. Patients in the private medical insurance group lost more excess weight (0.280±0.132, p<0.034) compared to those with publicly funded insurance. Additionally, individual studies suggest that socioeconomically deprived patients and those on Medicaid have a greater chance of readmission (18% vs. 10%) and residual sleep apnea (17.9% v 7.1%, p<0.0003).

CONCLUSIONS: Patients in the low socioeconomic class have worse post operative bariatric surgery outcomes when compared to those in the high socioeconomic class.

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