The impact of the affordable care act on access to bariatric surgery in Maryland

Oluwasegun A Akinyemi; Terhas A Weldeslase; Mojisola Fasokun; Yasmin Griffiths; Tsion Andine; Eunice Odusanya; Mallory Williams; Kakra Hughes; Edward Cornwell 3rd; Terrence Fullum

doi:10.1016/j.amjsurg.2023.12.021

The impact of the affordable care act on access to bariatric surgery in Maryland

Am J Surg. 2023 Dec 26:S0002-9610(23)00667-0. doi: 10.1016/j.amjsurg.2023.12.021. Online ahead of print.

Affiliations

¹ Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA. Electronic address: oluwasegun.akinyemi@howard.edu.
² Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.
³ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA.
⁴ Department of Surgery, Howard University College of Medicine, Washington, DC, USA.

PMID: 38171943
DOI: 10.1016/j.amjsurg.2023.12.021

Abstract

Introduction: This study aims to investigate the influence of the Affordable Care Act (ACA) on the utilization of Roux-en-Y gastric bypass (RYGB) procedures in Maryland.

Methods: Using the Maryland State Inpatient Database, this retrospective study compared all patients undergoing RYGB during the pre-ACA (2007-2009) and post-ACA (2018-2020) periods, including patient demographic factors, pre-existing conditions, and socioeconomic factors.

Results: A total of 16,494 RYGB procedures were performed during the study period, of which 12,089 (73.3 %) were post-ACA. This was a 179.2 % increase in patients undergoing RYGB post-ACA; nearly triple that of the pre-ACA period. There was a significant decrease in uninsured patients (5.6 %-1.5 %, p < 0.01) an increase in Black patients (32.1 %-46.8 %, p < 0.01) and Medicaid beneficiaries (6.0 % pre-ACA to 17.8 % post-ACA, p < 0.01). There were significant reductions in adverse outcomes (long hospital stays, hemorrhage, GIT leaks, and mortality) across all insurance types (all p < 0.01).

Conclusion: The ACA increased access to RYGB procedures, especially in Black and Medicaid recipients in Maryland, enhancing healthcare across all insurance types.

Keywords: Affordable care act; Health disparities; Healthcare policy; Obesity; Roux-en-Y gastric bypass surgery.