Does Insurance Status Influence Bariatric Surgery Outcomes?

Tara Mokhtari, Archana Nair, Narges Karmini, Dan Azagury, Homero Rivas, John Morton. Stanford University

INTRODUCTION: Bariatric surgery remains an enduring treatment to achieve long-term weight loss in the morbidly obese. While insurance now widely covers bariatric procedures, the relationship between insurance type and weight loss remains unclear. This study aims to evaluate the impact of insurance status on outcomes following three laparoscopic bariatric surgeries: Roux-en-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), and adjustable gastric banding (LAGB).

METHODS AND PROCEDURES: At a single academic institution, 1136 patients undergoing bariatric surgery were included in this prospective study. Pre- and post-operatively, demographic information, anthropometric measurements, standard lab data, and insurance status were collected. Patients were placed into one of four groups based on insurance status: 1) Private (P); 2) Medicare <55 years old (y/o) (M<55); 3) Medicare ≥55 years old (M≥55); and 4) Medicaid (MC). Comparison of pre- and post-operative weights, comorbidity resolution rates, and standard lab data was accomplished with one-way ANOVA and chi-squared analysis as appropriate for continuous and categorical variables respectively. All analysis was performed using STATA software release 12.

RESULTS: In this cohort, insurance distribution was 81.7% Private, 4.9% Medicare <55y/o, 6.9% Medicare ≥55y/o, and 6.5% Medicaid. Preoperative data revealed that as expected, patients in the M≥55 group were older (average ages, P: 45.6, M<55: 42.8, M≥55: 59.2, MC: 40.3, p<0.000). Preoperative rates of comorbid conditions varied by insurance, with Medicare ≥55y/0 having the highest rate of diabetes (53.9%, p=0.004), and Medicaid having the highest rate of hypertension (83.3%, p<0.000). There was no significant difference in preoperative rates of hyperlipidemia. There were no differences in complication or readmission rates among the four groups. Postoperatively, patients in all insurance classes achieved substantial weight loss. There was no statistical difference in 12-month percent excess weight loss (%EWL) based on insurance status, however Medicare patients <55 y/o trended to achieve lower %EWL than other insurance classes (P: 69.9%, M<55: 64.3%, M≥55: 65.2%, MC: 71.9%, p=0.142). Across insurance types, Medicare <55 y/o had the highest BMIs both preoperatively (average BMI=49.3, p<0.000) and postoperatively (average BMI=34.29, p=0.032). Medicaid patients, although few in number, saw significantly higher resolution rates of comorbid conditions including hypertension (91%, p=0.021), hypercholesterolemia (90%, p=0.036), and diabetes (94%, p=0.028). Medicare patients of all ages experienced the lowest resolution rates for these three comorbidities. Interestingly, at 12-months there was no significant difference in biochemical markers of these comorbid conditions including HbA1c, fasting glucose, LDL, HDL, Triglycerides, and Triglyceride/HDL ratio among the four insurance classes.

CONCLUSION: This study showed that 12-months following surgery, patients in all four insurance categories experienced considerable weight reduction and improvements in obesity-related comorbidities.