The Patient Journey of Bariatric Surgery – a Study Comparing the Healthcare and Medication Utilization before and after the Bariatric Surgery

OBJECTIVES:

This study aims to explore real-world trends in weight change, medication prescribing patterns, and healthcare utilization pre- and post-metabolic bariatric surgery (MBS).

METHODS:

This was a single-site, retrospective study using electronic health record data from an integrated delivery network in Texas. Adults receiving MBS between 01/01/2016 and 12/31/2017 were included. The date of MBS was the patient’s index date. The baseline period was 12 months before the index date. To assess outcomes 3 years post-MBS, a follow-up period at 30 to 42 months after the index date was used. Body mass index (BMI), medication orders for classes related to obesity comorbidities, and rates of hospitalizations and outpatient visits were compared between baseline and follow-up periods. Descriptive statistics, paired t-tests for continuous data, and McNemar tests for categorical data were used.

RESULTS:

A total of 655 patients (mean age, 49 years; 540 [82%] women) were included in the study. Patients had a statistically significant decrease in BMI from baseline to three years post-MBS (BMI 46.41±9.91 vs. 37.44±8.86, p<0.001). GLP-1 RAs were prescribed in 3.66% of patients at baseline and 7.02% in the follow-up period; SGLT-2s were 1.37% and 1.98%; insulin was 33.89% and 10.99%, antihypertensives were 46.26% vs. 31.30%, and antihyperglycemics were 19.39% vs. 11.30%. There was a statistically significant lower use of antihypertensives (p<0.001, OR=0.46, [95% CI, 0.35, 0.59]) and insulin (p<0.001, OR=0.11, [95% CI, 0.07, 0.18]) and a statistically significant higher use of GLP-1 RAs (p=0.0023, OR=2.47, [95% CI, 1.32, 4.84]) in the follow-up period. Moreover, participants had statistically significant lower hospitalization rates (0.79±0.65 vs. 0.16±0.64, p<0.001) and outpatient encounters (19.97±14.27 vs. 13.56±13.82, p<0.001) in the follow-up period.

CONCLUSIONS:

MBS is associated with long-term weight loss, reduced healthcare utilization, and decreased use of medication related to obesity comorbidities. The significant increase in GLP-1 RA utilization should be further explored.