MSS856: IMPACT OF BENEFICIARY STATUS ON HEALTHCARE UTILIZATION 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: Healthcare utilization following bariatric surgery, including readmissions and emergency department (ED) visits, remains an important metric for quality and cost of care. Understanding patterns of utilization across different patient populations can inform postoperative care strategies. We aimed to compare readmissions, ED visits, and postoperative complications between retirees and dependents undergoing bariatric surgery, hypothesizing that beneficiary status may influence healthcare utilization.
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. Continuous variables were compared using t-tests or Wilcoxon tests; categorical variables were compared using Chi-square or Fisher’s exact tests as appropriate. Readmissions and ED visits were analyzed using univariate and Firth’s penalized logistic regression, adjusting for preoperative comorbidities, operative time, intraoperative and postoperative complications, and index hospital length of stay (LOS).
Results: A total of 122 patients were included: 66 (54.1%) dependents and 56 (45.9%) retirees. Retirees were older (mean age 49.6 vs 43.2 years, p<0.001) and more frequently male, with higher prevalence of preoperative hypertension (58.9% vs 36.4%, p=0.018) and obstructive sleep apnea (80.4% vs 57.6%, p=0.011). Procedures performed included Roux-en-Y gastric bypass (68/122, 55.7%) and sleeve gastrectomy (54/122, 44.3%), which did not differ between groups. At 30 days, readmissions were significantly higher among dependents compared to retirees (18.2% vs 3.6%, p=0.015), as were ED visits (34.8% vs 17.9%, p=0.042). At 6 and 12 months, differences in readmissions and ED visits were not statistically significant. Firth’s logistic regression demonstrated that dependents had 1.59 times greater odds of 30-day readmission (95% CI 1.03–3.26, p=0.012) and 2.5 times greater odds of 30-day ED visits (95% CI 1.1–5.7, p=0.041) after adjusting for comorbidities, operative time, intraoperative and postoperative complications, and index hospital LOS. Total complications within 12 months were similar between groups (21.2% vs 17.9%, p=0.82).
Conclusions: Dependents undergoing bariatric surgery experienced higher early healthcare utilization, with increased 30-day readmissions and ED visits compared to retirees. These findings suggest that beneficiary status may influence early postoperative resource use, highlighting the importance of tailored perioperative support for dependents to potentially reduce short-term readmissions and ED visits.