Oluwasegun A. Akinyemia oluwasegun.akinyemi@howard.edu ∙ Terhas A. Weldeslasea ∙ Mojisola Fasokunb ∙ Yasmin Griffithsa ∙ Tsion Andinea ∙ Eunice Odusanyaa ∙ Mallory Williamsc ∙ Kakra Hughesc ∙ Edward Cornwell, IIIc ∙ Terrence Fullumc
Highlights
•The implementation of the Affordable Care Act led to increased utilization and access to bariatric surgery, specifically Roux-en-Y gastric bypass, among minority groups in Maryland
• Despite a higher proportion of higher-risk surgical patients, including elderly, Medicaid beneficiaries, and low-income patients, postoperative outcomes improved in the post-ACA period in Maryland.
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.
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