Insurance Status Predicts 30-Day Serious Complications, Length of Stay, and Emergency Department Visits Following Bariatric Surgery: An Analysis of 3,867 Cases
Wills M1; Weigand I1, Kachornvitaya P1, Zhu X1, Barajas-Gamboa J2; Lee Y1, Rosenthal R3, Corcelles R1, Strong A1, Dang J1, Navarrete S1, Kroh M1, Mocanu V1
1Cleveland Clinic Foundation; 2Cleveland Clinic Abu Dhabi; 3Cleveland Clinic Florida
Background & Objectives
•Publicly insured patients experience higher complication rates and greater healthcare utilization following surgery
•While insurance-based outcome disparities are well described nationally, their persistence at high-volume tertiary bariatric centers remains poorly characterized
•We examined whether insurance status independently predicts complications, ED visits, length of stay (LOS), and readmissions
Methods
•Retrospective analysis of the Cleveland Clinic MBSAQIP database (2020–2024) of primary bariatric surgery at a high-volume tertiary bariatric center
•Private insurance (PI) defined as commercial insurance or self-pay; non-private insurance (NPI) as Medicare or Medicaid
•Extended LOS defined as ≥3 days
•Patient characteristics and 30-day outcomes were compared using chi-squared and t-tests; multivariable logistic regression identified independent predictors of serious complications, ED visits, extended LOS, and readmission
Key Outcomes
•Of 3,867 patients, 55.3% had PI; NPI patients were more likely Black, had higher BMI, and greater comorbidity burden (all p<0.001)
•PI patients had fewer serious complications (3.4% vs. 5.6%, p=0.001), ED visits (10.3% vs. 18.1%, p<0.0001), shorter LOS (1.7 vs. 2.1 days, p<0.0001), and fewer readmissions (2.9% vs. 4.5%, p=0.004).
•Private insurance was independently protective against ED visits (OR 0.51), serious complications (OR 0.54), and extended LOS (OR 0.56) on multivariable analysis (Figure I).
Conclusions
•Private insurance is independently protective against serious complications, ED visits, and extended LOS following primary bariatric surgery
•Insurance-based outcome disparities persist even at a high-volume tertiary bariatric center
•NPI patients present with higher comorbidity burden and are disproportionately Black, reflecting broader socioeconomic disparities
•High-risk NPI patients may benefit from dedicated perioperative pathways, even at experienced bariatric centers
