PRE-OPERATIVE CLINICAL VARIATIONS BY HEALTH INSURANCE IN WOMEN WITH OBESITY DO NOT RESOLVE AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)

Objectives: Women comprise approximately 80% of patients with obesity who undergo LYRGB. However, variation by health insurance status in pre-operative clinical characteristics and in post-LRYGB outcomes specifically in women has not been investigated. The objective is to identify significant variations by health insurance status in pre-LRYGB demographics and clinical characteristics and in post-LYRGB outcomes among women with obesity.

Methods: With the approval of the Surgical Review Corporation Data Access Committee and the IRB of Inspira health network, HIPAA compliant records of 65,325 LRYGB women were analyzed in for groups: Medicare (4291), Medicaid (3932), Private (48385), and Self Pay (3932). Data included age, race, BMI, health insurance status, and the percentage frequency of angina, asthma, congestive heart failure (CHF), hypertension (HTN), obstructive sleep apnea (OSA), pulmonary hypertension (PHT), peripheral vascular disease (PVD), obesity hypoventilation syndrome (OHS), diabetes, dyslipidemia, gout, pseudotumor cerebri, PCOS, abdominal hernia, cholelithiasis, gastroesophageal reflux disease (GERD), liver disease, abdominal panniculitis, stress incontinence, back pain, musculoskeletal pain, functional impairment, lower extremity edema, depression, mental health diagnosis (MHD), psychological impairment (PI), substance abuse, tobacco use, alcohol use. Statistics: Continuous variables were evaluated by ANOVA and dichotomous variables with a general linear modified for binomial distribution.

Results: Medicare were oldest (54+-12 years), Medicaid youngest (41+-11 years) p< 0.0001. Medicaid were highest African-American (17.4%), Private highest Caucasian (75%), Self highest Asian (0.3%) and Hispanic (15.1%), p< 0.0001. Baseline through 24 months Medicaid BMI was highest and Private lowest despite a 12+ drop in BMI for all insurances, p< 0.0001. All 29 obesity co-morbidities varied significantly by insurance pre-LRYGB, as did 26/29 12 months and 24/29 24 months. Pre-LRYGB Medicare was highest in 18 co-morbidities, Medicaid 9, Private 1 (alcohol use) and Self-Pay (PCOS). 12 months Medicare highest 9, Medicaid 15, Private 2 (PCOS, alcohol). 24 months Medicare highest 9, Medicaid 13, Private 1 (PCOS), Self-Pay 1 (alcohol). See Table.

Conclusion: Wide clinically and statistically significant variations in BMI and serious co-morbidities by health insurance status observed pre-operatively persisted through 24 months post-LRYGB among women with obesity. While Medicare suffered the most medical problems pre-LRYGB, after major weight loss by 12 months, this older group had resolved more issues than Medicaid, who carried more co-morbidities, especially pulmonary and psychological, through 24 months. Surgeons should understand high Medicare risks pre-LRYGB and increased Medicaid co-morbidity retention post-LRYGB.