Background

Insurance plan types have been shown to influence the access and utilization of bariatric surgery. Few studies have investigated whether insurance type affects postoperative outcomes of bariatric surgery. The aim of this study was to compare outcomes in bariatric surgery patients with private insurance and patients with insurance from the Centers for Medicare and Medicaid Services (CMS).

Methods

This was a retrospective review of our institutional registry data evaluating patients after primary Roux-en-Y gastric bypass and vertical sleeve gastrectomy in the study period January 2010 to July 2022.

Results

The study included 684 CMS patients and 4905 private insurance patients. Compared to private insurance patients, CMS patients were significantly older with higher BMI and higher incidence of pre-existing functional dependency or comorbidities. CMS patients were also more likely to undergo a longer procedure compared to private insurance patients (134 minutes versus 121 minutes, p<0.01). Short term outcomes were mostly similar between the two groups, with CMS patients more likely to visit the emergency department (16.14% of CMS patients versus 10.28% of private insurance patients, p<0.01). Weight loss at 1 year was significantly higher in private insurance patients compared to CMS patients (114.22 pounds versus 75.70 pounds, p<0.01), with change in BMI at 1 year similar between the two groups.

Conclusions

When compared to patients with private insurance, patients with Medicare or Medicaid are older, heavier, and have more comorbidities. They are more likely to experience longer operating times, postoperative ED visits, and less weight loss at 1 year.