F. Moreno-Garcia1, R. Tran1, K. P. Mihalsky2, F. Mier-Giraud2, L. E. Fischer2 1University Of Oklahoma College Of Medicine, College Of Medicine, Oklahoma City, OK, USA 2University Of Oklahoma College Of Medicine, Department Of Surgery, Oklahoma City, OK, USA
Introduction:
Obesity affects 42% of US adults. Despite bariatric surgery's proven efficacy, only 1% of eligible individuals undergo surgery. Barriers include insurance-related challenges and mandated waiting periods. Public insurance correlates with lower bariatric surgery rates, despite higher prevalence of obesity and related comorbidities. Many public insurance programs require time to establish lifestyle changes. However, limited data exists regarding the impact of insurance status, distance to surgery centers, and time-to-surgery on outcomes such as weight loss.
Methods:
A retrospective study was conducted at the University of Oklahoma, analyzing data from adult bariatric surgery cases between June 2017 and October 2021. Collected data encompassed BMI, ZIP code, insurance status, time-to-surgery, and one-year post-surgery percent excess body weight loss (%EBWL). The distance from patient ZIP codes to the University of Oklahoma Health Science Center (OUHSC), where the surgeries took place, was calculated. Statistical methods included one-way ANOVA for %EBWL and insurance status, and linear regression for time-to-surgery, distance, and %EBWL. Oklahoma Medicaid mandated a minimum 6-month program enrollment before surgery. Significance was set at P < 0.05.
Results:
The study involved 133 patients with one-year follow-up data. Surgical procedures comprised 44% Roux-en-Y gastric bypass (RYGB), 53% vertical sleeve gastrectomy (VSG), and 3% revision surgeries. Insurance distribution was 77.4% commercial, 18.0% Medicare, and 4.5% Oklahoma Medicaid. The average program duration was 164 ± 84 days. Time-to-surgery varied: 162 ± 79 days for commercial, 145 ± 66 days for Medicare, and 198 ± 102 days for Medicaid. No significant %EBWL difference at one year existed based on insurance (P=0.297) or distance from OUHSC (P=0.4837). Remarkably, a significant negative correlation was observed between time-to-surgery and one-year %EBWL (P=0.0013).
Conclusion:
Publicly insured individuals exhibit elevated obesity rates and related health issues, yet they are less inclined to undergo bariatric surgery. Notably, weight loss outcomes are consistent across insurance types, supporting previous findings for Medicaid recipients. Geographical distance from the surgery center does not notably impact %EBWL, potentially due to the rise of virtual visits post-COVID-19. Most significantly, extended time-to-surgery negatively associates with one-year %EBWL, emphasizing the detrimental effects of mandated insurance wait-times on effective obesity care. Hence, vigilant monitoring is crucial for patients with prolonged program durations, highlighting the urgency to remove unnecessary barriers to enhance obesity treatment outcomes.
