Healthcare cost and utilization of bariatric surgical patients with and without preoperative mental health diagnoses

Background: Postoperative healthcare cost and use among patients with and without preoperative mental health illness are not well known. Objective: This study compared total healthcare spending and use (emergency department [ED] visits and inpatient admissions) after 1 year post operation of those with and without preoperative mental health disorders. Setting: United States. Methods: Mental illness disorders were identified using International Classification of Disease-9/10 diagnosis codes in a statewide bariatric surgery registry and in claims databases that were linked to identify the study cohort. Generalized linear regression and zero-inflated negative binomial regression were used for the healthcare cost and use outcomes. Results: Among 3580 registry patients with private insurance, 1610 patients with continuous enrollment and without missing body mass index data were included. Among patients, 56.8% (n = 915) had diagnosed mental health disorders before surgery. Those with mental illness spent more in total cost than those without mental illness (unstandardized coefficient = $18,513, P value < .01) in the first year after surgery. Those with mental illness had a 73% higher rate in ED visits (P value < .01), 83% higher rate in preventable ED use (P value < .01), and a 101% higher rate in hospital admissions (P value < .01) than those without mental illness. Conclusions: Patients with mental health diagnoses before having bariatric surgery appear to have significant positive association with surgical outcomes relating to postsurgical healthcare cost and utilization. Greater postsurgical surveillance may be warranted for bariatric surgery patients with preoperative mental illness to reduce postoperative ED visits and inpatient admissions. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.