Bariatric Surgery Utilization Trends in the United States Following COVID-19 and the 2022 ASMBS/IFSO Guideline...

Background: In the US, obesity is still a serious public health issue. Bariatric surgery utilization has recently been influenced by the COVID-19 pandemic and the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS)/International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guideline expansion. The combined effects of these events on national utilization trends remain unclear. Methods: We conducted a retrospective longitudinal study using electronic medical record data from the TriNetX network, including adults aged ≥18 years from 2018 through 2024. Primary bariatric procedures were identified using validated CPT and ICD codes. Quarterly surgery rates per 100,000 adults were calculated using the number of unique adults with at least one healthcare encounter per quarter as the denominator. Level and slope changes related to the start of COVID-19 (Q2 2020) and the application of the 2022 ASMBS guidelines (Q1 2022) were evaluated using interrupted time series models. Procedure-type distributions were also evaluated. Results: A total of 215,072 procedures were identified. Utilization was stable before Q2 2020, when a significant decline occurred following the onset of COVID-19. Rates recovered through 2021. After Q1 2022, a modest immediate increase was observed, followed by a sustained downward trend through 2024. Sleeve gastrectomy accounted for approximately two-thirds of procedures throughout the study period. Conclusions: Bariatric surgery utilization was markedly disrupted by COVID-19 and showed limited sustained growth after guideline expansion. These patterns might be a reflection of more general changes in the management of obesity, such as the growing accessibility of medication.