학술논문
Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States.
Document Type
Academic Journal
Author
Weldeslase TA; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Akinyemi OA; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Keeling DJ; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Enchill KA; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Cornwell EE 3rd; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.; Fullum TM; Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
Source
Publisher: SAGE Publications in association with Southeastern Surgical Congress Country of Publication: United States NLM ID: 0370522 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-9823 (Electronic) Linking ISSN: 00031348 NLM ISO Abbreviation: Am Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The passage of the Affordable Care Act (ACA) in 2010 marked a pivotal moment in American health care policy, significantly expanding access to health care services. This study aims to explore the relationship between the ACA and the utilization and outcomes of Roux-en-Y Gastric Bypass (RYGB) surgery.
Methods: Using data from the National Inpatient Sample (NIS) Database, this retrospective study compares the pre-ACA period (2007-2009) with the post-ACA period (2017-2019), encompassing patients who had RYGB. Multivariable logistic analysis was done accounting for patient's characteristics, comorbidities, and hospital type.
Results: In the combined periods, there were 158 186 RYGB procedures performed, with 30.0% transpiring in pre-ACA and 70.0% in the post-ACA. Post-ACA, the proportion of uninsured patients decreased from 4.8% to 3.6% ( P < .05), while Black patients increased from 12.5% to 18.5% ( P < .05). Medicaid-insured patients increased from 6.8% to 18.1% ( P < .05), and patients in the poorest income quartile increased from 20% to 26% ( P < .05). Patients in the post-ACA period were less likely to have longer hospital stays (OR = .16: 95% CI .16-.17, P < .01), in-hospital mortality (OR = .29: 95% CI .18-.46, P < .01), surgical site infection (OR = .25: 95% CI .21-.29, P < .01), postop hemorrhage (OR = .24: 95% CI .21-.28, P < .01), and anastomotic leak (OR = .14: 95% CI .10-.18, P < .01) than those in the pre-ACA period.
Discussion: Following the implementation of the ACA, utilization of bariatric surgery significantly increased, especially among Black patients, Medicaid beneficiaries, and low-income patients. Moreover, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.
Methods: Using data from the National Inpatient Sample (NIS) Database, this retrospective study compares the pre-ACA period (2007-2009) with the post-ACA period (2017-2019), encompassing patients who had RYGB. Multivariable logistic analysis was done accounting for patient's characteristics, comorbidities, and hospital type.
Results: In the combined periods, there were 158 186 RYGB procedures performed, with 30.0% transpiring in pre-ACA and 70.0% in the post-ACA. Post-ACA, the proportion of uninsured patients decreased from 4.8% to 3.6% ( P < .05), while Black patients increased from 12.5% to 18.5% ( P < .05). Medicaid-insured patients increased from 6.8% to 18.1% ( P < .05), and patients in the poorest income quartile increased from 20% to 26% ( P < .05). Patients in the post-ACA period were less likely to have longer hospital stays (OR = .16: 95% CI .16-.17, P < .01), in-hospital mortality (OR = .29: 95% CI .18-.46, P < .01), surgical site infection (OR = .25: 95% CI .21-.29, P < .01), postop hemorrhage (OR = .24: 95% CI .21-.28, P < .01), and anastomotic leak (OR = .14: 95% CI .10-.18, P < .01) than those in the pre-ACA period.
Discussion: Following the implementation of the ACA, utilization of bariatric surgery significantly increased, especially among Black patients, Medicaid beneficiaries, and low-income patients. Moreover, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.