Background

Prior studies have shown that socioeconomic factors, in particular Medicare and Medicaid patients, have an increased risk of postoperative complications compared to privately insured patients following bariatric surgery. This study assesses whether payer status had an impact on bariatric surgery outcomes.

Methods

The MBSAQIP database at Mount Sinai Health System was queried to identify primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cases from 2011-2023. Data regarding patient payer status and surgical outcomes were analyzed.

Results

Of the 1,564 patients who underwent primary bariatric surgery, the payer status was: 48.5% Medicaid, 42.2% private insurance, 7.6% Medicare and 1% self-pay. Medicaid patients were more likely to undergo SG compared to privately insured or Medicare patients (79% Medicaid, 72.6% Private, 62.7% Medicare, p<0.001). No statistically significant difference was seen in ED readmission following bariatric surgery (9.4% Medicaid, 8.7% Private, 6.7% Medicare, p=0.62). Additionally, no difference was noted in overall complication rates across the twelve metrics tracked within the MBSAQIP database by payer status (5.1% Medicaid, 4.4% Private, 5.8% Medicare p=0.090) or when analyzed by individual complication.

Conclusions

For patients undergoing bariatric surgery at our institution, there were no differences in ED readmissions or overall complications between different payer statuses. Multi-institutional studies are needed to illuminate the factors and practice patterns that may mitigate the disparities in bariatric surgery outcomes on a national level.