The Impact of Patient Distance from Hospital on Length of Stay and Postoperative Outcomes Following Bariatric Surgery

Following the recent Centers for Medicare and Medicaid Services proposal to classify several bariatric operations as outpatient procedures, there has been renewed interest in the factors that influence patients' postoperative lengths of stay (LOS). Multiple patient- and procedural factors associated with LOS following bariatric surgery have been studied, but the impact of patient distance from the hospital remains poorly understood. Therefore, we aimed to determine the impact of patient distance from the hospital on LOS, readmissions, and postoperative complications.

Patients who underwent bariatric surgery at an accredited high-volume bariatric center from 2016 to 2022 were identified. Patients were compared according to travel distance, utilizing continuous distance as well as quartiles. Outcomes of interest included prolonged LOS (≥2 days), 30-day readmissions, and complications. Associations between patient distance from the hospital and outcomes were evaluated by calculating a linear correlation coefficient as well as fitting multivariable logistic regression models adjusting for patient and procedural factors and clustered at the surgeon level.

A total of 1510 patients underwent bariatric surgery and traveled a median of 20.6 miles (IQR: 13.3-55.8). Of included patients, 799 (52.9%) were discharged by the end of postoperative day 1. The overall 30-day readmission rate was 5.9% (n = 89) and the overall rate of 30-day complications was 7.3% (n = 110). There was no linear relationship between the continuous distance and LOS (correlation coefficient: 0.013, p = 0.608). On multivariable analysis, patient travel distance was not associated with prolonged LOS (Q4 vs. Q1: 47.3% vs. 47.4%, aOR:1.25, 95% CI: 0.83-1.87), readmissions (Q4 vs. Q1: 6.4% vs. 5.9%, aOR: 1.16, 95% CI: 0.45-2.98), or complications (Q4 vs. Q1: 7.5% vs. 5.9%, aOR: 1.30, 95% CI: 0.78-2.16).

Postoperative LOS is one of several important factors in determining the classification between inpatient and outpatient status. In this evaluation, patient travel distance was not associated with total LOS after bariatric surgery, prolonged LOS, 30-day postoperative readmissions, or complications. Nearly half of the patients required hospital stays of 2 days, suggesting that current proposals to classify bariatric surgery as an outpatient procedure may need reconsideration.