The Impact of Medicaid Status on Outcome After Gastric Bypass

Background Socioeconomic status has been a predictor of poor outcome in many surgical diseases including morbid obesity. Potential differences in treatment and initial severity of disease have often not been well controlled in patients with bariatric surgery. This study was performed to compare the...

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Bibliographic Details
Published in:Obesity surgery 2008-10, Vol.18 (10), p.1241-1245
Main Authors: Alexander, J. Wesley, Goodman, Hope R., Hawver, Lisa R. Martin, James, Laura
Format: Article
Language:English
Subjects:
Adult
Body Mass Index
Clinical outcomes
Cohort Studies
Female
Gastric Bypass
Gastrointestinal surgery
Humans
Insurance Coverage
Insurance, Health
Male
Medicaid
Medicine
Medicine & Public Health
Middle Aged
Obesity
Obesity, Morbid - complications
Obesity, Morbid - mortality
Obesity, Morbid - surgery
Research Article
Retrospective Studies
Social Class
Socioeconomic factors
Surgery
Treatment Outcome
United States
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Summary:Background Socioeconomic status has been a predictor of poor outcome in many surgical diseases including morbid obesity. Potential differences in treatment and initial severity of disease have often not been well controlled in patients with bariatric surgery. This study was performed to compare the results of bariatric procedures in financially disadvantaged Medicaid patients compared to patients with Medicare and those with Commercial insurance under controlled conditions. Methods Prospectively collected data from 183 Medicaid, 77 Medicare and 570 Commercial/self-pay insurances were compared to determine the influence of poor economic status on outcome. All the patients received surgical care by the same surgeon at a large University-affiliated private hospital. Results Medicaid patients were larger (BMI 58.4 vs. 52.8 and 50.9, respectively) and had a greater incidence of serious comorbid conditions at outset. The death rate and complications were also significantly higher postoperatively in Medicaid patients. However, when the patients were matched for age and BMI, results became similar. Conclusion Increases in postoperative mortality and morbidity appear to be associated with advanced disease because of poor access to care. When matched for age, BMI, and severity of disease, outcomes are similar. Changes in Medicaid policies could improve access and outcome.
ISSN:0960-8923
1708-0428
DOI:10.1007/s11695-008-9615-7