Medicare and Medicaid status predicts prolonged length of stay after bariatric surgery

Abstract 

Background

The outcomes of Medicare patients undergoing bariatric surgery have been particularly scrutinized, especially with the Center of Medicare and Medicaid Services’ decision to offer bariatric surgery benefits.

Methods

The length-of-stay (LOS) data were analyzed from the National Hospital Discharge Survey from 2002 to 2004. To test the hypothesis that Medicare and Medicaid beneficiaries were more likely to have a prolonged length of stay (PLOS), we used a multivariate logistic regression model controlling for age, gender, hospital size, and year of procedure.

Results

An estimated 312,000 bariatric procedures were performed nationally from 2002 to 2004. The average patient age was 41.5 years (range 14–75) and 83.6% were women. The in-hospital mortality rate was reported to be .17%. A PLOS occurred in 3.7% of the population. The Medicare and Medicaid beneficiaries represented 5.7% and 6.2% of the population, respectively. The Medicare beneficiaries were 6.0 times (95% confidence interval 2.5–14; P <.001) as likely to have a PLOS, and Medicaid beneficiaries were 3.2 times (95% confidence interval 1.2–8.9; P = .02) as likely to have a PLOS as others after controlling for age, gender, hospital size, and year of procedure. For every 10-year increase in age, the risk of a PLOS increased by 30% (P <.012).

Conclusion

Medicare and Medicaid beneficiaries are both at an increased risk of a PLOS. This study was not designed to identify the potential causes of a PLOS. Data from prospectively collected bariatric registries might aid surgeons in assessing the risk/benefit ratio of surgical interventions in groups regarded as high risk.

Keywords: Outcomes research, Medicare, Medicaid, Bariatric surgery, National Hospital Discharge Survey