TY - JOUR
T1 - Preoperative insurance status influences postoperative complication rates for gastric bypass
AU - Martin, Louis F.
AU - Tan, Tjiauw Ling
AU - Holmes, Pamela A.
AU - Becker, Dolores A.
AU - Horn, John
AU - Mann, Lowell D.
AU - Bixler, Edward O.
N1 - Funding Information:
From the Departmentosf Surgery (LFM, PAH), Psychiatry(T LT, JH, LDM, EOB), and Clinical Nutrition (DAB) and The University Weight Management Center (LFM, TLT, DAB, JH, LDM, EOB), The Milton S. Hershey Medical Center. Pennsylvania State University, Hershey, Pennsylvania. Supported in part by grant HL 01502 from the National Institutes of Health, Bethesda, Maryland.
PY - 1991/6
Y1 - 1991/6
N2 - One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p < 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 ± 15.3 kg for the publicly funded group versus 43.1 ± 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 ± 18.4% versus 75.7 ± 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery.
AB - One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p < 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 ± 15.3 kg for the publicly funded group versus 43.1 ± 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 ± 18.4% versus 75.7 ± 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery.
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U2 - 10.1016/0002-9610(91)91244-D
DO - 10.1016/0002-9610(91)91244-D
M3 - Article
C2 - 1830719
AN - SCOPUS:0025939033
VL - 161
SP - 625
EP - 634
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 6
ER -