E. Y. Chen1, B. Fox1, A. Suzo2, S. A. Jolles1, J. A. Greenberg1, G. M. Campos1, M. J. Garren1, L. M. Funk1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA
Introduction:
The Medicaid system pays for nearly half of the obesity-related medical costs in the U.S. with 45 states providing bariatric surgery coverage to varying degrees. Given that new Medicaid enrollments have reached nearly seven million people since passage of the Affordable Care Act in 2010, understanding bariatric surgery outcomes and costs for Medicaid patients is critical. The purpose of this study is to compare one-year surgical outcomes and costs between Medicaid and non-Medicaid patients who underwent laparoscopic Roux-en-Y gastric bypass surgery.
Methods:
Our study is a retrospective review that included all patients who underwent a primary laparoscopic Roux-en-Y gastric bypass from January 1, 2010 to June 1, 2013 at the University of Wisconsin Hospital and Clinics (220 patients). Of these patients, 33 Medicaid patients were identified and matched with 99 non-Medicaid patients (1:3 study design). Ninety-day and one-year outcomes and complications were extracted from electronic medical records. One-year facility costs (inpatient, outpatient, and emergency department) were obtained from the UW information technology division. Fisher’s exact and students T-tests or Wilcoxon rank sums were used to compare categorical and continuous variables, respectively.
Results:
Medicaid patients were younger (age 39.0 vs. 48.7; p<0.001) but had similar preoperative body mass indices (49.6 vs. 47.1; p=0.09) and similar preoperative comorbidities with the exception of hyperlipidemia (24.2% vs. 50.5%; p=0.01) when compared to non-Medicaid patients (Table 1). Length of stay (2.2 vs. 2.3 days; p=1.00) and 90-day overall complication rates (42.4 vs. 31.3; p=0.29) were similar between Medicaid and non-Medicaid patients, respectively. Emergency department visits (48.2% vs. 27.4%; p =0.06) and hospital readmissions (37.0% vs. 14.7%; p=0.01) were more common for Medicaid patients. Medicaid patients had less overall excess body weight loss (50.7% vs. 65.6%; p =0.001) but had similar rates of comorbidity resolution one year following surgery. Median overall costs during the one-year follow-up period were similar between Medicaid and non-Medicaid patients ($21,160 vs. $24,215; p=0.92). There were no deaths during the one-year follow-up period.
Conclusion:
One-year outcomes following laparoscopic Roux-en-Y gastric bypass were largely similar between Medicaid patients and non-Medicaid patients at our institution. Emergency department visits and readmissions were more common for Medicaid patients, but this did not translate into increased costs for the Medicaid system. Concern for increased overall costs may not be a valid justification for state Medicaid programs to deny their patients bariatric surgery coverage.
