Insurance Payer Status and Risk of Major Adverse Cardiovascular and Cerebrovascular Events after Metabolic & Bariatric Surgery.

Background Patients with Medicare/Medicaid insurance utilize metabolic and bariatric surgery (MBS) at lower rates compared to the privately insured (PI). While some surgical procedures report that Medicare/Medicaid insurance confers increased post-operative complication rates and longer length of stay, less is known about these outcomes following MBS.. Among often-feared post-operative complications are major adverse cardiovascular events (MACE). Although MACE is rare after MBS, these events have a significant impact on morbidity and mortality. Objectives This study aimed to examine the effect of insurance payer status on MACE after MBS. Setting The Healthcare Cost and Utilization Project (HCUP) and National Inpatient Sample (NIS). Methods HCUP—NIS was queried for cases including sleeve gastrectomy or Roux-en-Y gastric bypass between 2012-2019. Bivariate associations between patient-level factors and MACE were assessed via Rao-Scott chi-square tests. Adjusted and unadjusted risk of insurance payer status for MACE were evaluated using logistic regression. Results Incidence of MACE was higher in both Medicare (0.75% vs 0.11% p<0.001) and Medicaid (0.15% vs. 0.11% p<0.001) groups compared to PI. After adjustment for high-risk demographics, high-risk co-morbidities, socio-economic variables, and hospital factors, insurance status of Medicare (OR1.60(1.23,2.07) p=0.0026) or Medicaid (OR1.55(1.12,2.16) p=0.0026) remained an independent risk factor for MACE. Conclusions Our findings underscore the significance of Medicaid/Medicare payor status as independent predictors of post-operative MACE in MBS. The results of this study could have significant impact on deepening our understanding of socioeconomic and health system-related issues that could be targeted to improve outcomes in both MBS and other surgical specialties.