title: Bariatric aftercare and outcomes in the Medicaid population following sleeve gastrectomy.
abstract: BACKGROUND
  Medicaid patients tend to have poor access to care and suffer from more obesity and obesity-related co-morbidities compared to their privately insured counterparts. The impact of Medicaid status on outcomes after laparoscopic sleeve gastrectomy (LSG) is unknown. The aim of this study was to identify factors that influence outcomes following LSG in the adult Medicaid population of Louisiana with particular focus on adherence to bariatric aftercare attendance and access to care.
  
  
  METHODS
  A retrospective review of 63 Medicaid patients undergoing LSG was performed. Demographic data, access to care, weight, co-morbidities morbidity, and mortality were analyzed. Changes in weight and obesity-related co-morbidities were analyzed for patients with ≥12 months of follow-up. Regression analyses were used for estimating the relationships among variables.
  
  
  RESULTS
  The majority of patients were female and non-Caucasian. The mean age was 38.6 years. Morbidity was 16% and mortality was 0%. The average distance traveled to clinic was 71.9 miles. Within the first year only 10% of the patients attended all post-operative clinic visits. A multiple logistic model showed that the only predictor of clinic attendance was increased age. At a mean follow-up of 17.7 months, the mean percent excess body weight loss was 47.2%. Greater pre-surgical weight was the only variable associated with suboptimal weight loss. Improvement or resolution of all major co-morbidities was seen in 65% of patients.
  
  
  CONCLUSIONS
  Medicaid patients had a poor attendance at bariatric surgery follow up appointments. Since long-term follow-up is critical, we needed to develop strategies that will optimize follow-up in this patient population.
authors.affiliation: Department of Surgery, Tulane University, New Orleans, Louisiana, USA.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bellows
authors.affiliation: Department of Surgery, Tulane University, New Orleans, Louisiana, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Gauthier
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University, New Orleans, Louisiana, USA.
authors.forename: Larry S
authors.initials: LS
authors.lastname: Webber
mesh_terms: D000328:Adult; D000359:Aftercare / Q000191:economics / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008484:Medicaid; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss
keywords: Aftercare; Laparoscopic sleeve gastrectomy; Medicaid; Outcomes