• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Insurance mandated preoperative medical visits do not correlate with bariatric surgical outcomes

Pornthep Prathanvanich, MD, Katherine Bohnstedt, APN, P Marco Fisichella, MD, Sharfi Sarker, MD, Bipan Chand, MD. Loyola University Chicago Stritch School of Medicine.

Introduction
Morbidly obese patients seeking surgical weight loss therapy are often required to meet arbitrary months of dietary counseling prior to surgical intervention. Often there is a discrepancy between the amount of insurance required preoperative visits and the amount of visits based on clinical needs. We sought to analyze these differences and their effects on outcomes.

Methods
All individuals seeking obesity treatment  undergo education on obesity risks, treatment options as well as thorough medical, psychological and nutritional validated screening questionnaires prior to individual multi-disciplinary visits. Patients are considered high or low risk for intervention based on face-to-face interaction evaluating for presence of eating disorders, significant life-threatening illnesses, super obesity, and revisional bariatric surgery.  Payors also require an arbitrary number of preoperative visits with varying duration times prior to surgical intervention. Analyzed are insurance requirements, time in a clinical pathway, demographics, and outcomes of low and high risk patients undergoing bariatric surgery.

Results
In this IRB approved registry, 90 individuals met criteria for analysis. Based on insurance policies, 66 patients required no insurance mandated nutritional visits and 24 patients required 3 – 6 months of preoperative nutritional (Table1). 

Then patients were divided in to four groups for further analysis. Group 1 had no insurance mandated preoperative time constraints and was considered low risk. Group 2 had 3-6 months of insurance mandated visits with low risk. Group 3 had no insurance mandated preoperative time constraints yet was considered high. Group 4 required 3-6 months of mandatory preoperative visits and was considered high risk. The primary outcome was change of BMI at various perioperative time points.
There were no demographic or anthropometric measurement differences between the four groups and type of surgery. Group4, despite having an increased time in the program, had an overall significant increase of BMI (1.21±1.25) prior to surgery (p= 0.02 with Group1 and p=0.008 with Group2). The other groups had a modest decrease in BMI that was not significantly different. Body mass index at initial visit, after insurance mandated time and post-operatively are shown without statistical difference.

Conclusion
Arbitrary insurance mandated preoperative visits did not influence perioperative changes in body mass index. Clinical pathways better predict the need for individualized medical and psychological optimization prior to surgical intervention. This imbalance of mandated healthcare service should be re-evaluated in today’s medical environment.
 

  Insurance requirement P value Clinical pathway P value
0 month 3-6 months Low risk High risk
  ( N = 66 )  ( N = 24 )    ( N = 58 )  ( N = 32 )  
   LRYGB/LSG/LAGB 25/11/30 6/7/11 0.329 20/12/26 11/6/15 0.971
Time before suragery (Days) 136.21±98.12 180.42±109.11 0.070 140±82 163±131.99 0.315

Starting BMI

(kg/m2)

45.89±8.58 48.54±8.83 0.203 46.27±7.32 47.18±10.82 0.636
BMI at time of surgery 44.83±7.72 47.68±8.49 0.135 44.88±6.41 46.88±10.23 0.259
Decrease in BMI before surgery 1.05±2.61 0.85±2.99 0.755 1.38±2.98 0.30±1.95 0.069
BMI at last FU 37.27±7.67 40.38±8.88 0.107 37.42±7.01 39.34±9.72 0.283
TimeFU(Days) 270.30±109.13 257.25±104.68 0.613 253.38±101.49 291.19±115.36 0.111
Decrease in BMI at last FU 7.55±4.35 7.30±4.00 0.799 7.46±4.18 7.53±4.41 0.940

 

View Poster

87

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2014 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons