Insurance-mandated weight management program completion before bariatric surgery provides no long-term clinical benefit |
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| Institution: | 1. Department of Surgery, Prisma Health, Greenville, South Carolina;2. Data Support Core, Prisma Health, Greenville, South Carolina;3. School of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina;1. B2M Medical Inc., Irvine, California;2. Department of Radiology, Wayne State University, Detroit, Michigan;3. Department of Radiology, Ascension Providence Rochester Hospital, Rochester, Michigan;4. Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana;5. Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana;6. Louisville Metabolic and Atherosclerosis Research Center, Inc., Louisville, Kentucky;7. Division of General Internal Medicine, Department of Medicine, University of California, San Diego, California;8. Bariatric and Metabolic Institute, Division of Minimally Invasive Surgery, Department of Surgery, University of California, San Diego, California;9. Department of Surgery, Baylor College of Medicine, Houston, Texas;1. Harvard Medical School, Boston, Massachusetts;2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada;3. Massachusetts General Hospital, Boston, Massachusetts;1. Center for Clinical and Translational Science and Training, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;2. Division of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;4. Department of Surgery, Lurie Children''s Hospital of Chicago, Chicago, Illinois;5. Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio |
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| Abstract: | BackgroundThere is no evidence that insurance-mandated weight loss before bariatric surgery affects outcomes.ObjectiveThis retrospective study evaluated the relationship between insurance-mandated weight management program (WMP) completion before primary bariatric surgery and postoperative outcomes.SettingSuburban academic medical center.MethodsPatients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 572) or sleeve gastrectomy (SG, n = 484) from 2014 to 2019 were dichotomized to presence (LRYGB n = 431, SG n = 348) or absence (LRYGB n = 141, SG n = 136) of insurance-mandated WMP completion. Primary endpoints included follow-up rate, percent total weight loss (%TWL), and percent excess weight loss (%EWL) through 60 months after surgery. The Mann-Whitney U test compared between-group means with significance at P < .05.ResultsFollow-up rate, %TWL, and %EWL were not different (P = NS) up to 60 months postoperation between groups for either surgery. Both LRYGB and SG patients without WMP completion maintained greater %TWL (LRYGB: 34.4 ± 11.1% versus 29.8 ± 11.0%, P = .159; SG: 21.4 ± 10.0% versus 18.2 ± 10.5%, P = .456) and %EWL (LRYGB: 71.3 ± 26.3% versus 67.6 ± 26.5%, P = .618; SG: 49.2 ± 18.8% versus 47.5 ± 28.8%, P = .753) at 36 months after surgery. Secondarily, duration of time to get to surgery was significantly greater among yes-WMP patients (LRYGB: 178 days versus 121 days, P < .001; SG: 169 days versus 95 days, P < .001).ConclusionInsurance-mandated WMP completion before bariatric surgery delays patient access to surgery without improving postoperative weight loss potential and must be abandoned. |
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| Keywords: | Insurance Weight reduction program Preoperative period Bariatric surgery Weight loss |
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