One-year Surgical Outcomes and Costs for Medicaid Versus Non-Medicaid Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass

Abstract

Purpose To compare one-year outcomes and costs between severely obese Medicaid and non-Medicaid patients who underwent laparoscopic Roux-en-Y gastric bypass surgery. Methods Single institution, retrospective review comparing 33 Medicaid patients to 99 randomly selected non-Medicaid patients (1:3 case-control). 90-day and one-year outcomes were extracted from the electronic health record. Costs were obtained from the UW information technology division. Bivariate analyses were used to compare study variables. Results Emergency department visits (48.2% vs. 27.4%; p=0.06) and readmissions (37.0% vs. 14.7%; p=0.01) were more common for Medicaid patients. Medicaid patients had less excess body weight loss (50.7% vs. 65.6%; p=0.001) but similar comorbidity resolution and complication rates. One-year median costs were similar between Medicaid and non-Medicaid patients ($21,160 vs. $24,215; p=0.92). Conclusion One-year comorbidity resolution, complications and costs following laparoscopic Roux-en-Y gastric bypass were similar between Medicaid and non-Medicaid patients. Focusing on reducing ED presentations and readmissions would be a high impact area for future quality improvement initiatives.

Reduction in Comorbid Conditions Over 5 Years Following Bariatric Surgery in Medicaid and Commercially Insured Patients

“…Baseline. Our study further substantiates the existing body of evidence (13)(14)(15)(16)(17) that has suggested that Medicaid patients present for surgery with a greater burden of comorbid disease despite representing a slightly younger population. All but two comorbidities were more common among Medicaid patients.…”

Weighing in on Bariatric Surgery: Effectiveness Among Medicaid Beneficiaries—Limited Evidence and Future Research Needs

“…Despite these baseline differences, four of the seven studies reported similar proportions of weight lost at follow‐up among Medicaid and commercially insured patients . Three studies reported less weight loss in Medicaid recipients.…”

“…All seven studies reporting on weight outcomes observed a substantial weight reduction in all insurance groups . The reported outcome variables included the percent of excess weight lost, difference in weight or BMI between time points, and weight loss classified as suboptimal (Table ).…”

“…Three studies reported less weight loss in Medicaid recipients. In the first two, Medicaid recipients lost a significantly lower percent of total excess body weight at follow‐up (65.6% non‐Medicaid vs. 50.7% Medicaid ; 64.6% non‐Medicaid vs. 53.8% Medicaid ). In the third study, Medicaid recipients were twice as likely to have suboptimal weight loss, defined as the failure to lose at least 40% of excess body weight by 1 year following surgery; however, this finding was not statistically significant (95% CI: 0.7‐3.2) .…”

“…Six studies examined obesity‐related comorbidities , most commonly type 2 diabetes mellitus (DM), hypertension, hyperlipidemia, or obstructive sleep apnea (Table ). Four of the six studies reported baseline prevalence of comorbidities, all but one of which observed greater prevalence of preoperative comorbid conditions in Medicaid beneficiaries.…”