Payor status differences in 30-day and 1-year outcomes after primary laparoscopic bariatric surgery.

Background: There was a call for research regarding safety and efficacy of bariatric surgery in Medicare beneficiaries. Payor status may be an indicator of both health and socioeconomic status.

Objectives: The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) sought to explore the association of insurance type in U.S. patients receiving primary bariatric surgery on both postoperative risks and benefits.

Setting: Not-for-profit organization, clinical data registry.

Methods: MBSAQIP data from primary laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) cases performed in 2021 along with follow-up records through 18 months postoperatively were included (N = 156,046). All analyses were stratified by age (<65 years, n = 149,949; ≥65 years, n = 6097). Hierarchical logistic regression models for 30-day adverse events, and longitudinal models for percent total weight loss and cox regression models for mortality and comorbidity remission rates through 1 year were performed.

Results: Among those <65 years, Medicare patients showed greatest risk for 30-day postoperative complications followed by Medicaid, private insurance, and self-pay patients aligning with preoperative risk profiles. Private insurance holders <65 years lose 1.5% more of their total preoperative weight and show greater rates of comorbidity remission at 12 months than Medicare patients. Across all payor groups <65 years, scenario-based survival probabilities through 1-year are ∼99%, 25% total weight loss or greater is realized, and 33% to over 75% of those with respective comorbidities experience remission. No meaningful payor status differences were noted among those ≥65 years.

Conclusions: Payor status may be an indicator of both health and socioeconomic status, where traditional risk adjustment is inappropriate. Results reinforce these complex relationships, but also prove immense benefits of bariatric surgery regardless of payor type.