{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:26:15Z","timestamp":1780928775815,"version":"3.54.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009913","name":"Naval Medical Center San Diego","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009913","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Retirees and dependents represent demographically and clinically distinct beneficiary groups within the Military Health System (MHS). We assessed whether beneficiary status influences perioperative outcomes, healthcare utilization, and weight loss after bariatric surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of adults undergoing sleeve gastrectomy or Roux-en-Y gastric bypass from 01\/01\/2022 to 12\/31\/2024 at a single military treatment facility. Outcomes were stratified by beneficiary status (retiree versus dependent). Propensity scores incorporating demographic, clinical, and procedural factors were used to construct overlap weights, yielding covariate balance comparable to randomized allocation. Overlap-weighted logistic and linear regression models assessed the independent association between beneficiary status and postoperative outcomes. Sex interaction terms evaluated effect modification. A female-only 1:1 propensity score-matched analysis served as a sensitivity analysis to address marked sex imbalance between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 281 patients, 123 (43.8%) were retirees and 158 (56.2%) dependents. Retirees were older (median 50 versus 46\u00a0years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), predominantly male (52% versus 7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), higher frequency Black (12.2% versus 5.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.052) and Hispanic (22.8% versus 11.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017) and had higher comorbidity burden (median count 5.0 versus 4.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Revision\/conversion procedures were less common in retirees; otherwise, operative indices were comparable. In unadjusted analyses, retirees had shorter hospital length of stay (LOS), fewer all-cause ED visits at 30\u00a0days, and fewer surgical ED visits through 12\u00a0months. However, in weighted regression, beneficiary status was not independently associated with LOS, ED visits, readmissions, or short-term percent total weight loss. No significant sex\u2013beneficiary status interaction was observed. In the female-only matched cohort (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009114; 57 pairs), outcomes again remained comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After covariate adjustment using overlap weighting and sex-restricted propensity matching, beneficiary status was not independently associated with LOS, postoperative healthcare utilization, or short-term weight loss. These findings suggest equitable bariatric outcomes across MHS beneficiary groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12860-z","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:25:44Z","timestamp":1779125144000},"page":"5347-5357","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of beneficiary status on bariatric surgery outcomes in a military treatment facility"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8865-0267","authenticated-orcid":false,"given":"Michael T.","family":"Olson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Beom","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Masella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Layton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"1","key":"12860_CR1","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.ypmed.2004.10.012","volume":"41","author":"AM Kress","year":"2005","unstructured":"Kress AM, Hartzel MC, Peterson MR (2005) Burden of disease associated with overweight and obesity among U.S. military retirees and their dependents, aged 38-64, 2003. Prev Med 41(1):63\u201369. https:\/\/doi.org\/10.1016\/j.ypmed.2004.10.012","journal-title":"Prev Med"},{"issue":"2","key":"12860_CR2","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1038\/oby.2011.2","volume":"20","author":"TD Koepsell","year":"2012","unstructured":"Koepsell TD, Littman AJ, Forsberg CW (2012) Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity 20(2):434\u2013439. https:\/\/doi.org\/10.1038\/oby.2011.2","journal-title":"Obesity"},{"issue":"11","key":"12860_CR3","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1002\/oby.20566","volume":"21","author":"M Tanofsky-Kraff","year":"2013","unstructured":"Tanofsky-Kraff M, Sbrocco T, Theim KR et al (2013) Obesity and the US military family. Obesity 21(11):2205\u20132220. https:\/\/doi.org\/10.1002\/oby.20566","journal-title":"Obesity"},{"issue":"1","key":"12860_CR4","first-page":"3","volume":"16","author":"JD Mancuso","year":"2023","unstructured":"Mancuso JD, Young J, Rusiecki J et al (2023) Advancing health equity in the US military. J Health Disparities Res Pract 16(1):3","journal-title":"J Health Disparities Res Pract"},{"issue":"10","key":"12860_CR5","doi-asserted-by":"publisher","first-page":"5810","DOI":"10.1007\/s00464-020-08079-1","volume":"35","author":"M Aranda","year":"2021","unstructured":"Aranda M, Ling J, Chang W, Faler B (2021) An evaluation of bariatric surgery in all military treatment facilities. Surg Endosc 35(10):5810\u20135815. https:\/\/doi.org\/10.1007\/s00464-020-08079-1","journal-title":"Surg Endosc"},{"issue":"1","key":"12860_CR6","doi-asserted-by":"publisher","first-page":"9521","DOI":"10.1038\/s41598-024-57724-5","volume":"14","author":"LZ Pipek","year":"2024","unstructured":"Pipek LZ, Moraes WAF, Nobetani RM et al (2024) Surgery is associated with better long-term outcomes than pharmacological treatment for obesity: a systematic review and meta-analysis. Sci Rep 14(1):9521. https:\/\/doi.org\/10.1038\/s41598-024-57724-5","journal-title":"Sci Rep"},{"key":"12860_CR7","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jss.2019.04.081","volume":"243","author":"JH Mehaffey","year":"2019","unstructured":"Mehaffey JH, Hawkins RB, Charles EJ, Sahli ZT, Schirmer BD, Hallowell PT (2019) Socioeconomically distressed communities associated with long-term mortality after bariatric surgery. J Surg Res 243:8\u201313. https:\/\/doi.org\/10.1016\/j.jss.2019.04.081","journal-title":"J Surg Res"},{"issue":"2","key":"12860_CR8","doi-asserted-by":"publisher","first-page":"e2022.00009","DOI":"10.4293\/JSLS.2022.00009","volume":"26","author":"B Clapp","year":"2022","unstructured":"Clapp B, Vivar A, Castro C et al (2022) Rates of readmission and emergency department visits of publicly versus commercially insured patients in a metabolic and bariatric surgery accreditation and quality improvement program accredited center. JSLS 26(2):e2022.00009. https:\/\/doi.org\/10.4293\/JSLS.2022.00009","journal-title":"JSLS"},{"issue":"4","key":"12860_CR9","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.amjsurg.2022.09.049","volume":"225","author":"LM Funk","year":"2023","unstructured":"Funk LM, Alagoz E, Murtha JA et al (2023) Socioeconomic disparities and bariatric surgery outcomes: a qualitative analysis. Am J Surg 225(4):609\u2013614. https:\/\/doi.org\/10.1016\/j.amjsurg.2022.09.049","journal-title":"Am J Surg"},{"issue":"Suppl 2","key":"12860_CR10","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1093\/cdn\/nzaa063_075","volume":"4","author":"J Roe","year":"2020","unstructured":"Roe J, Bustillos B, Kieffer A (2020) Clinical outcomes of bariatric surgery among military retirees and beneficiaries: a retrospective cohort study. Curr Dev Nutr 4(Suppl 2):1677. https:\/\/doi.org\/10.1093\/cdn\/nzaa063_075","journal-title":"Curr Dev Nutr"},{"issue":"4","key":"12860_CR11","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1007\/s11695-020-05169-w","volume":"31","author":"A Caponera","year":"2021","unstructured":"Caponera A (2021) Bariatric surgery and Type 2 diabetes remission rates: a retrospective cohort study comparing military veterans and beneficiaries. Obes Surg 31(4):1618\u20131624. https:\/\/doi.org\/10.1007\/s11695-020-05169-w","journal-title":"Obes Surg"},{"issue":"11","key":"12860_CR12","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1001\/archsurg.141.11.1115","volume":"141","author":"EH Livingston","year":"2006","unstructured":"Livingston EH, Langert J (2006) The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg 141(11):1115\u20131120. https:\/\/doi.org\/10.1001\/archsurg.141.11.1115","journal-title":"Arch Surg"},{"issue":"4","key":"12860_CR13","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344\u2013349. https:\/\/doi.org\/10.1016\/j.jclinepi.2007.11.008","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"12860_CR14","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/000313481808400326","volume":"84","author":"AN Lee","year":"2018","unstructured":"Lee AN, Johnson R, Lakhani I, Happe LE (2018) Outcomes at bariatric surgery centers of excellence and non-designated centers: a retrospective cohort study in a TRICARE population. Am Surg 84(3):410\u2013415","journal-title":"Am Surg"},{"issue":"12","key":"12860_CR15","doi-asserted-by":"publisher","first-page":"e193732","DOI":"10.1001\/jamasurg.2019.3732","volume":"154","author":"VA Smith","year":"2019","unstructured":"Smith VA, Arterburn DE, Berkowitz TSZ et al (2019) Association between bariatric surgery and long-term health care expenditures among veterans with severe obesity. JAMA Surg 154(12):e193732. https:\/\/doi.org\/10.1001\/jamasurg.2019.3732","journal-title":"JAMA Surg"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12860-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-026-12860-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12860-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:52:53Z","timestamp":1780926773000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-026-12860-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["12860"],"URL":"https:\/\/doi.org\/10.1007\/s00464-026-12860-z","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"assertion":[{"value":"7 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Olson MT, Lee YB, Masella P, and Layton B declare no relevant financial relationships or conflicts of interest. The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, the Department of War, or any agency of the United States Government.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}