Background

Patients with Medicare/Medicaid insurance utilize metabolic surgery (MS) at lower rates compared to the privately insured (PI). Individuals with Medicare/Medicaid insurance also have increased post-operative complications and longer length of stay. Among often-feared post-operative complications are major adverse cardiovascular events (MACE). Although rare after MS, MACE has a significant impact on morbidity and mortality, and this study aimed to examine the effect of insurance payer status on MACE outcomes after MS.

Methods

The Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) was used for the current study, a deidentified, publicly available dataset. Individuals undergoing sleeve gastrectomy or Roux-en-Y gastric bypass between 2012-2019 were included. Bivariate associations between patient-level factors and MACE were assessed via Rao-Scott chi-square tests and adjusted/unadjusted risk of insurance payer status for MACE were evaluated using logistic regression.

Results

MACE incidence was higher in both Medicare and Medicaid groups compared to PI (0.75/0.15% vs 0.11% p<0.001). After adjustment for high-risk demographics, co-morbidities, socio-economic, and hospital factors, insurance status of Medicare (OR1.60(1.23,2.07) p=0.0026) or Medicaid (OR1.55(1.12,2.16) p=0.0026) remained an independent risk factor for MACE.

Conclusions

Despite risk adjustment, Medicaid and Medicare insurance status remained independent risk factors for postoperative MACE after MS. The results of this study could have significant impact on deepening our understanding of socioeconomic and health system-related issues that could be targeted to improve outcomes in both MS and other surgical specialties.