Background

Postoperative emergency department (ED) utilization and readmissions are key quality outcome measures for Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers. Given rising costs, limiting postoperative resource utilization is paramount. The aim of this study is to investigate the effects of insurance payor status on post-operative resource utilization after metabolic surgery (MS).

Methods

Utilizing data from our institutional MBSAQIP (2020-2023), MS cases were identified and categorized based on primary payor. Analysis of 30-day readmissions, reinterventions, and reoperations was completed based on case characteristics and stratified by payor status to examine intergroup differences.

Results

Medicaid beneficiaries were overall younger (39.9 years vs. 46.5 years) than patients with private insurance (PI) and were more likely to be female. Body mass index (BMI) was significantly higher for Medicaid compared to PI or Medicare (48.3 vs. 46.5 vs. 45.3). Medicaid recipients had significantly higher rates of ED utilization (p<0.005) compared to PI and self-pay and higher rates of visits for IV hydration (p=0.007). Regardless, Medicaid status was not associated with increased composite complications, composite infection, length of stay >5 days, or readmission. Medicare beneficiaries had more ED visits compared to self-pay (p<0.005) and higher rates of 30-day readmissions and reoperations compared to PI (p<0.005).

Conclusions

Postoperative ED utilization and readmission/reoperation rates were notably higher in publicly insured patients compared to those with PI or self-pay. This highlights the importance of implementing targeted quality improvement measures to reduce avoidable ED visits within this population.