MSS854: IMPACT OF BENEFICIARY STATUS ON WEIGHT LOSS AND METABOLIC OUTCOMES AFTER BARIATRIC SURGERY AT A MILITARY TREATMENT FACILITY
Michael T Olson, MD; Yun Beom Lee, MD; Brian Layton, DO; Pamela Masella, DO; Department of Minimally Invasive and Bariatric Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
Objectives: Bariatric surgery is highly effective for weight reduction and metabolic improvement, but patient-specific factors may influence outcomes. We aimed to compare weight loss trajectories, metabolic outcomes, and therapy de-escalation between dependent and retiree beneficiaries from 12 to 24 months after bariatric surgery.
Methods: We performed a retrospective analysis of consecutive patients undergoing bariatric surgery between 01/01/2023 and 01/01/2024 by two surgeons at our tertiary military treatment facility. Patients were categorized as dependents or retirees based on military beneficiary status. Demographics, comorbidities, procedure type, and perioperative variables were collected. Weight loss was reported as total weight loss percentage (TWL%) at 6, 12, and 24 months. Metabolic outcomes included hemoglobin A1c (HbA1c), lipid profile, and prediabetes or type 2 diabetes mellitus resolution. Therapy outcomes included discontinuation of CPAP for obstructive sleep apnea and de-escalation of antihypertensives and statins. Continuous variables were compared using t-tests or Wilcoxon tests; categorical variables were analyzed with chi-square or Fisher’s exact tests.
Results: A total of 122 patients were included: 66 (54.1%) dependents and 56 (45.9%) retirees. Retirees were older (mean age 49.6 ± 8.1 vs 43.2 ± 11.7 years, p<0.001) and more often male, with higher rates of preoperative hypertension (58.9% vs 36.4%, p=0.018) and obstructive sleep apnea (80.4% vs 57.6%, p=0.011). Other comorbidities including type 2 diabetes mellitus, hyperlipidemia, chronic pain, and psychiatric diagnoses, were similar between groups. Bariatric surgery procedure did not differ significantly between groups. Mean preoperative weight was lower in dependents (106 ± 22.7 kg vs 117 ± 28.6 kg, p=0.022), though BMI was similar (41.0 ± 6.0 vs 40.1 ± 6.3, p=0.422). TWL% was comparable at 6 months (12.9% vs 22.0%, p=0.357), 12 months (18.2% vs 25.6%, p=0.466), and 24 months (11.9% vs 22.9%, p=0.466), with BMI reductions paralleling weight trends. Retirees demonstrated higher prediabetes resolution at 12 months (31.8% vs 7.1%, p<0.001). Medication de-escalation was more common in retirees at 12 months for statins (28.6% vs 7.6%, p=0.0027) and antihypertensives (14.3% vs 3%, p=0.029). CPAP discontinuation was more frequent in retirees (30.4% vs 13.6%, p=0.015). Mean lipid reductions at 12 months were similar between groups.
Conclusions: Both groups achieved substantial weight loss and metabolic improvement after bariatric surgery. Dependents trended toward slightly higher early TWL%, whereas retirees demonstrated higher rates of prediabetes resolution and therapy de-escalation. These findings highlight how baseline characteristics and beneficiary status may influence postoperative metabolic outcomes and medication management.