Morbid Obesity Management Insights: Pre-operative Clincial Variability by Insurance Carrier in 8,966 Sleeve Gastrectomy Patients

Grace W Kao, DO, Gus J Slotman, MD. Departments of Medicine and Surgery, Inspira Health Network, Vineland, New Jersey.

Introduction: Every pre-surgery clinical insight contributes to positive outcomes in the often perilous peri-operative management of medically fragile sleeve gastrectomy patients. While obesity co-morbidities are clear, differences in their prevalence by health insurance carrier are unknown. The objective of this study was to identify variation in the clinical characteristics of sleeve gastrectomy patients according to insurance type.

Methods and Procedures: Pre-operative data on 8,966 patients from the Surgical Review Corporation’s BOLD database who were about to undergo sleeve gastrectomy was studied in four health insurance groups: Medicaid, Medicare, Private, and Self-Pay.  Analysis of variance tested continuous variables. Dichotomous parameter distribution was assessed by the Chi-squared equation.

Conclusions: In sleeve gastrectomy patients, medical conditions vary widely by insurance status. Medicare patients are the oldest, heaviest, and manifest the highest rates of cardiopulmonary, hepatobiliary, metabolic, musculoskeletal, and mental health problems, in addition to having the highest unemployment rate. Medicaid patients, though youngest, have the highest F/M ratio, asthma, liver disease, and tobacco abuse. Private and Self-Pay drink and smoke but have the fewest co-morbidities. Awareness of increased surgical risks for obese Medicare and Medicaid patients should benefit both patients and surgeons in improving peri-operative outcomes.


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