NEW YORK (Reuters Health) – After undergoing gastric bypass surgery to treat morbid obesity, roughly one third of medically disabled patients on Medicaid can return to full-time work, according to a report in the October issue of the Archives of Surgery. The likelihood appears to be greatest among those with comorbidities that resolve after treatment.
"Bariatric surgery is the only effective treatment for morbid obesity," Dr. Richard C. Thirlby and associates maintain. In their practice at the Virginia Mason Medical Center in Seattle, many of the patients evaluated for weight-loss surgery are deemed medically disabled and are on Medicaid.
The team reviewed the records of these patients, who had been seen between 1997 and 2002 and followed for about 3 years. Outcomes for the 38 patients who had undergone Roux-en-Y gastric bypass were compared with those of 16 patients who had no surgery.
At baseline, mean BMI was 58 in the surgical group and 54 in the control group. The number of comorbid conditions averaged 4.0 and 3.1, respectively.
During follow-up, 14 (37%) patients in the surgery group had returned to work, versus one (6%) in the control group (p = 0.02).
Final BMI averaged 36 in the surgery group and 52 in the control group. However, the amount of weight lost or final BMI achieved were not associated with re-employment.
The number of comorbid illnesses increased in the control group and decreased in the surgery group. Conditions affected the most were gastroesophageal reflux disease, sleep apnea, and diabetes. The investigators found that patients who had greater than the mean reduction in number of comorbidities were more likely to return to the workforce (12 of 14, 86%, p = 0.001).
"Reduction of comorbidities is more reliable than the amount of weight lost as a predictor of patients’ ability to return to work," Dr. Thirlby and his associates conclude.
The investigators note, however, that patients with more than six preoperative comorbidities did not return to work, implying that "this subset of patients is perhaps too severely disabled to benefit from rehabilitation."
Arch Surg 2007;142:935-940.