Association of insurance status with postoperative resource utilization after metabolic/bariatric surgery-A multi-institutional study.

Abstract

Background: Postoperative emergency department (ED) use and readmissions are key quality outcome measures for Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) centers. Given increasing costs, limiting postoperative resource use is of paramount importance.

Objectives: This study aimed to investigate disparities in postoperative resource use after metabolic and bariatric surgery (MBS) across primary payor status.

Settings: Two MBSAQIP-accredited centers.

Methods: Using data from our institutional MBSAQIP dataset (2020-2023), MBS cases were identified and categorized on the basis of primary payor type. Analysis of 30-day readmissions, reinterventions, and reoperations was performed on the basis of case characteristics and stratified by payor status to examine intergroup differences.

Results: Medicaid beneficiaries were overall younger (40.4 years versus 46.5 years; P < .05) than patients with private insurance (PI) and more likely to be female. Body mass index was significantly greater for Medicaid compared with PI or Medicare (49.8 versus 47.8 versus 48.2; P < .05). Medicaid recipients had significantly greater rates of ED use (P < .0001) compared with PI and self-pay and longer operative times compared with PI and Self-Pay (144.8 min versus 126.7 versus 108.1 min; P < .05). Patients with Medicaid status also had a longer length of stay than patients with PI (1.68 days versus 1.48 days, P < .05). Despite these differences, Medicaid status was not associated with increased composite complications, composite infection, length of stay >5 days, or readmission.

Conclusions: Postoperative ED use and readmission/reoperation rates were notably higher in publicly insured (Medicare or Medicaid) patients compared with those with PI or self-pay. This highlights the importance of implementing targeted quality improvement measures to improve access to care in this population.