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Patient travel for bariatric surgery: does distance matter?

2016; Elsevier BV; Volume: 13; Issue: 12 Linguagem: Inglês

10.1016/j.soard.2016.12.025

1878-7533

J. Hunter Mehaffey, Alex D. Michaels, Mathew G. Mullen, Max O. Meneveau, John R. Pender, Peter T. Hallowell,

Obesity and Health Practices

Background Increasingly, patients are faced with greater travel distances to undergo bariatric surgery at high-volume centers. Objectives This study sought to evaluate the impact of travel distance on access to care and outcomes after bariatric surgery. Setting Patients who underwent Roux-en-Y gastric bypass at an academic bariatric surgery center from 1985 to 2004 were examined and stratified by patient travel distance. Methods Univariate analyses were performed for preoperative risk factors, 30-day complications, and long-term (10-yr) weight loss between “local,” defined as 1 hour of travel time. Survival analysis was performed with Kaplan-Meier and Cox proportional hazards models. Results A total of 650 patients underwent Roux-en-Y gastric bypass, of whom 316 (48.6%) traveled 1 hour. Median body mass index was equivalent between the groups (local, 52.9 kg/m2; regional, 53.2 kg/m2; P = .76). Patients who traveled longer distances had higher rates of preoperative co-morbidities, including chronic obstructive pulmonary disease, congestive heart failure, diabetes, and sleep apnea (all P<.05). Complications within 30 days of surgery and long-term reduction of excess body mass index were equivalent between groups. Travel time was an independent predictor of risk-adjusted reduced long-term survival (hazard ratio, 1.23, P = .0002). Conclusions A majority of patients who underwent bariatric surgery at our center traveled>1 hour. Despite longer travel time for care, 30-day complications and long-term weight loss were equivalent with that of local patients. As expected, patients who lived in close proximity were more likely to adhere to yearly follow-up in surgery clinic. Travel time was an independent predictor of risk-adjusted reduced long-term survival.