title: The impact of medicaid status on outcome after gastric bypass.
abstract: BACKGROUND
  Socioeconomic status has been a predictor of poor outcome in many surgical diseases including morbid obesity. Potential differences in treatment and initial severity of disease have often not been well controlled in patients with bariatric surgery. This study was performed to compare the results of bariatric procedures in financially disadvantaged Medicaid patients compared to patients with Medicare and those with Commercial insurance under controlled conditions.
  
  
  METHODS
  Prospectively collected data from 183 Medicaid, 77 Medicare and 570 Commercial/self-pay insurances were compared to determine the influence of poor economic status on outcome. All the patients received surgical care by the same surgeon at a large University-affiliated private hospital.
  
  
  RESULTS
  Medicaid patients were larger (BMI 58.4 vs. 52.8 and 50.9, respectively) and had a greater incidence of serious comorbid conditions at outset. The death rate and complications were also significantly higher postoperatively in Medicaid patients. However, when the patients were matched for age and BMI, results became similar.
  
  
  CONCLUSIONS
  Increases in postoperative mortality and morbidity appear to be associated with advanced disease because of poor access to care. When matched for age, BMI, and severity of disease, outcomes are similar. Changes in Medicaid policies could improve access and outcome.
authors.affiliation: Center for Surgical Weight Loss, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. jwesley.alexander@uc.edu
authors.forename: J Wesley
authors.initials: JW
authors.lastname: Alexander
authors.forename: Hope R
authors.initials: HR
authors.lastname: Goodman
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Martin Hawver
authors.forename: Laura
authors.initials: L
authors.lastname: James
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012923:Social Class; D016896:Treatment Outcome; D014481:United States