The impact of the affordable care act on access to bariatric surgery in Maryland

Abstract

IntroductionThis 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. MethodsUsing 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. ResultsA 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). ConclusionThe ACA increased access to RYGB procedures, especially in Black and Medicaid recipients in Maryland, enhancing healthcare across all insurance types.