Love Kaitlin M, Mehaffey J Hunter, Safavian Dana, Schirmer Bruce, Malin Steven K, Hallowell Peter T, Kirby Jennifer L
Department of Medicine, University of Virginia, Charlottesville, Virginia.
Department of Surgery, University of Virginia, Charlottesville, Virginia.
Surg Obes Relat Dis. 2017 May;13(5):871-876. doi: 10.1016/j.soard.2017.01.022. Epub 2017 Jan 13.
Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery.
Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery.
A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; P<.001); primary care physician letter of necessity (P<.0001); laboratory testing (P = .019); and evaluation by cardiology (P<.001), pulmonology (P<.0001), or psychiatry (P = .0003). Using logistic regression to control for co-morbidities, longer diet requirement (odds ratio [OR] .88, P<.0001), primary care physician letter (OR .33, P<.0001), cardiology evaluation (OR .22, P = .038), and advanced laboratory testing (OR 5.75, P = .019) independently predicted surgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, P<.0001).
Many prebariatric surgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care.
尽管缺乏证据表明可改善临床结局，但许多保险公司对减肥手术有相当多的术前要求。本研究的假设是，保险公司特定的要求将与手术进展减少和手术时间延迟增加相关。
对2010年至2015年接受减肥手术评估的患者进行回顾性数据收集。将接受手术的患者（SGY；n = 827；平均体重指数[BMI] 49.1）与未接受手术的患者（非SGY；n = 648；平均BMI：49.4）进行比较。进行单因素和多因素分析，以确定手术退出和手术时间的特定合并症和保险公司特定预测因素。
共纳入1475例使用12家主要保险公司支付方的患者。单因素分析发现与手术退出相关的保险要求包括更长的中位饮食持续时间（非SGY = 6个月；SGY = 3个月；P <.001）；初级保健医生的必要性信函（P <.0001）；实验室检查（P =.019）；以及由心脏病学（P <.001）、肺病学（P <.0001）或精神病学（P =.0003）进行的评估。使用逻辑回归控制合并症，更长的饮食要求（优势比[OR].88，P <.0001）、初级保健医生信函（OR.33，P <.0001）、心脏病学评估（OR.22，P =.038）和高级实验室检查（OR 5.75，P =.019）独立预测手术退出。此外，手术患者从初次就诊到手术的平均间隔为5.8±4.6个月，体重显著增加（2.1 kg，P <.0001）。
在本研究中，许多减肥手术前的保险要求与患者手术进展不足相关。此外，手术延迟与术前体重增加有关。尽管需要进行前瞻性和多中心研究，但这些发现具有重大政策意义，表明可能需要重新考虑保险要求以改善医疗护理。
