title: Bariatric surgery in Medicare patients: greater risks but substantial benefits.
abstract: BACKGROUND
  Recent reports have documented greater mortality for bariatric surgery in Medicare (MC) patients compared with patients from other payors.
  
  
  METHODS
  We reviewed our database for the mortality and outcomes of 282 MC and 3169 non-Medicare (NMC) patients undergoing bariatric surgery.
  
  
  RESULTS
  Of the MC patients, 27 were >65 years of age, and 255 were receiving disability. The average age was 48.45 +/- 11.8 years, and the average BMI was 52.4 +/- 10.0 kg/m2. NMC patients had average age of 40.0 +/- 10.1 years and a BMI of 50.6 +/- 9.1 kg/m2. The co-morbidities were greater in the MC patients than in the NMC patients (hypertension 71.9% versus 48.4%, diabetes mellitus 39.72% versus 19.4%, obstructive sleep apnea 46.45% versus 28.46%, and obesity hypoventilation syndrome 9.93% versus 2.71%). The mortality rate was 2.48% in the MC patients and .76% in the NMC patients. Mortality was absent in MC patients >65 years old. The percentage of excess weight lost was less in the MC patients (60.8%) than in the NMC patients (66.5%, P <.0001). The resolution of diabetes mellitus also differed (64.86% for the MC patients and 77.18% for the NMC patients; P = .0329). The male MC patients had more prevalent co-morbidities than did the male NMC patients (hypertension 79.17% versus 58.85%; diabetes mellitus 36.11% versus 24.83%; obstructive sleep apnea 79.17% versus 54.51%; and obesity hypoventilation syndrome 26.39% versus 7.64%). The operative mortality rate was 5.6% for the male MC patients and 1.5% for the female MC patients. The weight loss was similar for the male MC and male NMC patients. The male MC patients had slightly better resolution of both hypertension (MC patients 54.8% versus NMC patients 26.7%, P = .0025) and diabetes mellitus (MC patients 30% versus NMC patients 22.5%, P = .745). When the patients were stratified into low-, intermediate-, and high-risk groups using a previously validated risk scale, patients with similar risk factors had similar mortality in both groups.
  
  
  CONCLUSIONS
  The results of our study have shown that disabled MC patients have greater operative mortality than NMC patients that appears to be associated with more prevalent risk factors. However, the risk was counterbalanced by a substantial improvement in health.
authors.affiliation: Department of Surgery, Virginia Commonwealth University, Richmond, Virginia 232998-0519, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Yuan
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Martin Hawver
authors.forename: Peter
authors.initials: P
authors.lastname: Ojo
authors.forename: Luke M
authors.initials: LM
authors.lastname: Wolfe
authors.forename: Jill G
authors.initials: JG
authors.lastname: Meador
authors.forename: John M
authors.initials: JM
authors.lastname: Kellum
authors.forename: James W
authors.initials: JW
authors.lastname: Maher
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D050110:Bariatric Surgery / Q000401:mortality*; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality* / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D012306:Risk; D014481:United States / Q000453:epidemiology