OBJECTIVES: Laparoscopic (stapled) bariatric surgery (BxS; including sleeve gastrectomy [LSG] or Roux-en-Y gastric bypass [LRYGB]) is recognized as one of the most effective means to cause substantial and durable weight loss among severely obese patients. Furthermore, randomized trials and observational studies have shown particular benefit of BxS among patients with selected obesity-related comorbidities, including diabetes and hypertension. Over 90% of patients who undergo BxS are aged<65; however, no studies have explicitly described the characteristics of such patients aged<65 who have Medicare insurance coverage, which is primarily a source of insurance for those aged≥65.

METHODS: Retrospective, observational study based on hospital billing data from the Premier Healthcare Database. Studied patients (aged<65 years) underwent elective LSG/LRYGB for obesity between Jan-1-2010 and Dec-31-2016 (first LSG/LRYGB=index admission). Bivariate statistical analyses were used to compare characteristics measured during index admission between the study groups (commercial vs. Medicare patients).

RESULTS: Prior to applying the age selection criterion, 21,983 Medicare patients met all other selection criteria; most Medicare-covered patients (15,833, 72%) were aged<65. Final sample included 15,833 Medicare and 83,681 commercial patients. Compared with commercial patients, Medicare patients had a similar proportion of females (77.5% Medicare vs. 77.9% Commercial, P=0.26) and were slightly older (mean=48.3y vs. 43.3y, P<0.01). Comorbidities for which BxS has been shown to have a beneficial impact were more prevalent in Medicare patients than their commercial counterparts (hypertension, 70.5% vs. 54.9%, P<0.01; diabetes, 46.4% vs. 28.4%, P<0.01). Medicare patients also had a greater proportion of super obese patients (body mass index≥50, 31.7% vs. 22.3%, P<0.01).

CONCLUSIONS: Nearly three-quarters of Medicare patients undergoing laparoscopic BxS were aged<65. Compared to their commercially-covered counterparts, Medicare patients had higher levels of obesity and higher rates of comorbidities which respond to BxS, suggesting that such patients meet standard eligibility criteria for BxS.