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Abstract

Introduction: Extreme obesity is epidemic. With severe weight exacerbating and even causing critical illnesses, intensivists need every clinical clue with the mega-obese. However, the effects of insurance status on serious weight-related conditions are unknown. Hypothesis: Distribution of life-threatening cardiopulmonary, metabolic, and hepatobiliary derangements varies with health insurance type in mega-obese patients. Methods: Pre-operative data on 4,225 patients from the Surgical Review Corporation's BOLD database was examined in five groups: Medicaid (n=272), Medicare (n= 632), Private insurance (n=3,253), and Self-Pay (n=68). Continuous variables were tested by analysis of variance, and dichotomous variables by the Chi-squared equation. Results: BMI: Medicare 53+-11, Medicaid 53+-11, Private 50+-10, Self-Pay 54+-12 (p<0.05). Age: Medicare 53+-11 years vs 41+-11, 40+-11, 40+-12 (p<0.05). Hypertension: Medicare 76% vs 57%, 59%, 53% (p<0.0001). CHF: Medicare 9% vs 5%, 2%, 3% (p<0.0001). Ischemic heart disease: Medicare 11% vs 7%, 5%, 5% (p<0.0001). DVT/PE: Medicare 9% vs 7%, 3%, 0% (p<0.0001). Pulmonary hypertension: Medicare 7.4% vs 6.6%, 4.0%, 2.9% (p=0.0006). Obstructive sleep apnea (OSA): Medicare 64% vs 62%, 51%, 46% (p<0.0001). Asthma: Medicare 29% vs 28%, 20%, 15% (p<0.00010. Diabetes: Medicare 52% vs 36%, 37%, 28% (p<0.0001). Cholelithiasis: Medicare 31% vs 26%, 20%, 9% (p<0.0001). Liver disease: Medicare 16% vs 10%, 13%, 9% (p<0.0001). Angina: Medicaid 8%, Medicare 7%, Private 4%, Self-Pay 0% (p<0.0001). Conclusions: Systems failure in the mega-obese varies by health insurance status. Medicare patients are oldest and admit to the ICU with the highest arterial and pulmonary hypertension, CHF, ischemic heart disease, DVT/PE, diabetes, asthma, OSA, cholelithiasis, and liver disease. Medicaid patients will be younger, but have highest angina, plus cardiopulmonary disorders second only to Medicare. Obesity illnesses are less severe in Private patients, and least among Self-Pay, in spite of the highest BMI. In the ICU, anticipating increased organ systems fragility of mega-obese Medicare and Medicaid patients while managing their critical illnesses could be life-saving.