The effect of insurance status on bariatric surgical outcomes

Introduction In 1991, the NIH Consensus Conference on Gastrointestinal Surgery for Severe Obesity emphasized the importance of epidemiologic research in bariatric surgery: "The effects of surgical therapy should be defined in various subgroups stratified for gender, age, ethnicity, socioeconomic status, comorbidity, and fat distribution". Nearly twenty years later, the answer to whether socioeconomic status impacts outcomes remains unresolved. Methods Prospective data collected on bariatric surgical patients at 555 facilities participating in the American Society for Metabolic and Bariatric Surgery Bariatric Surgery Center of Excellence (BSCOE) program were collected between June 2007 and September 2009. 65,410 patients met inclusion criteria. Of these, 8,537 patients had insurance provided by Centers of Medicare and Medicaid Services (CMS); 7,090 with Medicare and 1,808 with Medicaid insurance. Demographic, clinical, perioperative and postoperative data were compared between patients with CMS insurance (CMS) and those whose surgery was covered by other insurers (non-CMS). Results CMS patients differ sharply from those covered by private insurance in terms of mean age (years) (53.0 vs 44.3; p Conclusions Patients insured by Medicare and Medicaid undergoing bariatric surgery present with a higher risk profile and suffer worse postoperative outcomes compared to those covered by private carriers. While the CMS patients may have the most to gain from the surgery, they also bring higher risks.