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<h5 class="section-title" id="d12666149e180">Background</h5>
<p id="P1">Many insurance companies have considerable pre-bariatric surgery requirements
despite
a lack of evidence for improved clinical outcomes. The hypothesis of this study is
that insurance-specific requirements will be associated with a decreased progression
to surgery and increased delay in time to surgery.
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<h5 class="section-title" id="d12666149e185">Methods</h5>
<p id="P2">Retrospective data collection was performed for patients undergoing bariatric
surgery
evaluation from 2010–2015. Patients who underwent surgery (SGY; n= 827; mean BMI 49.1)
were compared to those who did not (no-SGY; n= 648; mean BMI 49.4). Univariate and
multivariate analysis were performed to identify specific comorbidity and insurance
specific predictors of surgical dropout and time to surgery.
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<h5 class="section-title" id="d12666149e190">Results</h5>
<p id="P3">A total of 1475 patients using 12 major insurance payers were included.
Univariate
analysis demonstrated insurance requirements associated with surgical drop out included
longer median diet duration (no-SGY= 6 months; SGY=3 months; p< 0.001); PCP letter
of necessity (p<0.0001); laboratory testing (p=0.019); and evaluation by cardiology
(p<0.001), pulmonology (p<0.0001), or psychiatry (p=0.0003). Using logistic
regression
to control for comorbidities, longer diet requirement (OR 0.88, p<0.0001), PCP
letter
(OR 0.33, p<0.0001), cardiology evaluation (OR 0.22, p=0.038), and advanced laboratory
testing (OR 5.75, p=0.019) independently predicted surgery dropout. Additionally,
surgical patients had an average interval between initial visit and surgery of 5.8±4.6
months with significant weight gain (2.1 kg, p<0.0001).
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<h5 class="section-title" id="d12666149e195">Conclusion</h5>
<p id="P4">Many pre-bariatric surgery insurance requirements were associated with
lack of patient
progression to surgery in this study. In addition, delays in surgery were associated
with preoperative weight gain. Although prospective and multicenter studies are needed,
these findings have major policy implications suggesting insurance requirements may
need to be reconsidered to improve medical care.
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