Factors Associated With Long Wait Times for Bariatric Surgery
Alvarez R, Bonham AJ, Buda CM, Carlin AM, Ghaferi AA, and Varban OA. Factors Associated With Long Wait Times for Bariatric Surgery. Ann Surg 2019; 270(6):1103-1109.
Annals of surgery
BACKGROUND: Despite its proven safety and efficacy, bariatric surgery is an underutilized therapy for severe obesity. Wait times for surgery are largely unexplored in the United States and may impact access to care.
OBJECTIVE: To determine the amount of time between initial bariatric surgery clinic visit and operative date and identify factors associated with longer wait times.
METHODS: A statewide clinical data registry was queried from 2006 to 2016 and 60,791 patients undergoing primary bariatric surgery were identified. Demographics, comorbidities, 30-day complications, and 1-year patient-reported outcomes were compared between shortest and longest wait time quartiles. Analyses were performed using Chi-square, t-test, and logistic regression.
RESULTS: Median wait times for bariatric surgery increased from 86 to 159 days during the study period. Median wait times were ≤67 days for the shortest wait time quartile and ≥204 days for the longest wait time quartile. Factors independently associated with longer wait times included Medicaid insurance [odds ratio (OR) 3.02; 95% confidence interval (CI): 2.58-3.53], sleep apnea (OR 1.49; 95% CI: 1.41-1.58), psychological disorder (OR 1.25; 95% CI: 1.18-1.32), hyperlipidemia (OR 1.21; 95% CI: 1.14-1.28), smoking history (OR 1.11; 95% CI: 1.05-1.17), and white race (OR 0.665; 95% CI: 0.614-0.720). Preoperative weight loss, risk adjusted complication rates, postoperative self-reported weight loss, and comorbidity remission were similar between groups.
CONCLUSIONS: Over the past decade, eligible patients are experiencing longer wait times when pursuing bariatric surgery. Complex patients with Medicaid insurance are experiencing the longest delay despite similar outcomes and preoperative weight loss. Policies that delay surgery should be re-examined.