title: The effect of Medicaid status on weight loss, hospital length of stay, and 30-day readmission after laparoscopic Roux-en-Y gastric bypass surgery.
abstract: BACKGROUND
  Patients with Medicaid are much less likely to undergo bariatric surgery compared to those with commercial insurance. The aims of this study were to compare outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) for patients covered by Medicaid, other (non-Medicaid) government insurance, and commercial insurance.
  
  
  METHODS
  This was a retrospective cohort study of all eligible patients who underwent LRYGB between July 2004 and October 2011 at a single university hospital (n = 450). Multivariable regression analysis was used to compare percent weight loss (PWL), absolute weight loss (AWL), hospital length of stay (LOS) ≥3 days, and 30-day readmission rates. Analyses were adjusted for appropriate covariates.
  
  
  RESULTS
  There was a nonsignificant increase in PWL in Medicaid patients at 2 months (p = 0.08), 6 months (p = 0.09), and 12 months (p = 0.17) compared to commercial insurance patients. Similarly, there was a nonsignificant increase in AWL in Medicaid patients at 2 months (p = 0.054), 6 months (p = 0.08), and 12 months (p = 0.14) compared to commercial insurance patients. Medicaid patients had similar PWL and AWL compared to those with other government insurance (p ≥ 0.29 at all time points). Medicaid patients were more likely to have a hospital LOS ≥ 3 days (OR 2.03; 95 % confidence interval (CI) 1.09-3.77) and a hospital readmission within 30 days of discharge (odds ratio (OR) 2.84; 95 % CI 1.15-6.96) compared to commercial insurance patients.
  
  
  CONCLUSIONS
  These data should be considered as states expand Medicaid and make decisions regarding treatment of severe obesity. Interventions to decrease hospital LOS and the 30-day readmission rate, particularly in Medicaid patients, should be explored.
authors.affiliation: Department of Medicine, University of Colorado Denver, 12631 E. 17th Ave., Room 8603, Aurora, CO, USA, elsbeth.jensen-otsu@ucdenver.edu.
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Jensen-Otsu
authors.forename: Emily K
authors.initials: EK
authors.lastname: Ward
authors.forename: Breana
authors.initials: B
authors.lastname: Mitchell
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Schoen
authors.forename: Kevin
authors.initials: K
authors.lastname: Rothchild
authors.forename: Nia S
authors.initials: NS
authors.lastname: Mitchell
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Austin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D015431:Weight Loss / Q000502:physiology*