title: Two-year outcomes for medicaid patients undergoing laparoscopic Roux-en-Y gastric bypass: a case-control study.
abstract: BACKGROUND
  Millions of patients will be added to Medicaid programs throughout the country due to expansion driven by the Affordable Care Act. Since 90 % of state Medicaid programs cover bariatric surgery, the outcomes of Medicaid patients will be important to study. We performed a retrospective analysis to compare outcomes between Medicaid and non-Medicaid bariatric surgery patients over a two-year period.
  
  
  METHODS
  All patients who underwent a laparoscopic Roux-en-Y gastric bypass at The Ohio State University Medical Center from January 2008-April 2011 were identified. Of these 609 patients, 30 Medicaid patients were identified and compared to 90 randomly selected non-Medicaid patients (1:3 case-control). Preoperative data and postoperative outcome data (weight loss, comorbidity resolution, complications, and mortality) were obtained from electronic medical records. Descriptive statistical analyses were performed to compare categorical and continuous variables.
  
  
  RESULTS
  Medicaid patients had a significantly higher average BMI (58.4 vs. 49.5; p < 0.001) and higher rates of comorbidities. Over a 90-day postoperative period, Medicaid patients experienced a higher wound complication rate (20.0 vs. 5.6 %; p = 0.03) and visited the ER more frequently (33.3 vs. 10.0 %; p = 0.007) but had similar rates of medical complications compared to non-Medicaid patients. The Medicaid cohort lost 52.1 % of its excess body weight vs. 64.6 % for the non-Medicaid cohort (p = 0.02) over a two-year period. There were no significant differences in comorbidity resolution, anastomotic complications, or mortality after 2 years of follow-up.
  
  
  CONCLUSIONS
  Despite being a higher risk cohort, Medicaid patients undergoing laparoscopic Roux-en-Y gastric bypass had similar long-term outcomes compared to non-Medicaid patients.
authors.affiliation: Department of Surgery, Wisconsin Surgical Outcomes Research Group (WiSOR), University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H4/728 Clinical Science Center, Madison, WI, 53792-7375, USA, funk@surgery.wisc.edu.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.forename: Andrew
authors.initials: A
authors.lastname: Suzo
authors.forename: Dean J
authors.initials: DJ
authors.lastname: Mikami
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Needleman
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D009820:Ohio; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss