N. Javadi1, L. Garcia1, D. Azagury1, H. Rivas1, J. M. Morton1 1Stanford University,Bariatric And Minimally Invasive Surgery,Palo Alto, CA, USA
Introduction: Medicaid status has been associated with increased risk-adjusted mortality for major surgical operations. While previous studies have documented that disparities in post-operative outcomes vary as a function of insurance status, the influence of insurance status on cardiac outcomes of patients after bariatric surgery remains unknown. We hypothesize that primary insurance status significantly affects the cardiac outcomes of patients after undergoing bariatric surgery.
Methods: Patient data were obtained retrospectively from a bariatric surgery database at a single academic institution in California between 2009 and 2017. Patients who received either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) were categorized into three categories based on insurance status: private insurance, Medicare, or Medi-Cal. Patient demographic characteristics, BMI, weight, percent excess weight loss (%EWL), waist circumference, systolic/diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), fasting insulin, hemoglobin A1C (HbA1C), glucose, high sensitivity C-reactive protein (CRP), Lipoprotein(a) (Lp(a)), total plasma homocysteine (HmC), B-type natriuretic peptide (B-type BNP) and N-terminal pro b-type natriuretic peptide (NT-BNP) levels were collected at 6 and 12 months post-operatively. One-way analysis of variance (ANOVA), Kruskal-Wallis, and chi-square tests of association were conducted.
Results:A total of 2482 patients were studied; 1697 patients had private insurance, 490 had Medi-Cal, and 295 had Medicare. Patients were predominantly female in every insurance group. Regardless of insurance group, most patients underwent LRYGB. At 12 months postoperatively, 541 privately insured patients, 218 Medicare patients and 218 Medi-Cal patients were lost to follow up. Significant differences were ascertained between private insurance and Medi-Cal groups in BMI, total cholesterol, and LDL cholesterol. Significant differences between private insurance and Medicare groups were observed in BMI, %EWL, and serum concentrations of homocysteine. Significant differences between Medicare and Medi-Cal were observed for total and LDL cholesterol. NT-BNP levels were statistically different between all three groups.
Conclusion: This study demonstrates that differences in patient insurance influence cardiometabolic outcomes following bariatric surgery. These results indicate not only that, on average, Medicare and Medi-Cal patients have higher post-operative BMIs, but also that a lower proportion of patients with these forms of insurance attain a BMI within normal range 12 months after surgery relative to patients who are privately insured.