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Rurality and Metabolic and Bariatric Surgery Access and Outcomes in the Deep South
Marcus Sirianno1, M Chandler McLeod2, Eunise Chen2
1Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs, Veterans Health Administration, Office of Academic Affiliations VA Quality Scholars Advanced Fellowship Program, Birmingham, Alabama.
Bariatric surgery access and outcomes were similar for rural and non-rural patients in the Deep South. However, non-rural individuals showed greater BMI reduction and weight loss over time, and White patients had shorter hospital stays and more weight loss.
Area of Science:
- Surgical outcomes research
- Obesity treatment disparities
- Rural health access
Background:
- Bariatric surgery is an effective obesity treatment with good outcomes.
- Utilization is low in the Deep South, where rurality impacts care access.
- This study examines rural vs. non-rural bariatric surgery access and outcomes.
Purpose of the Study:
- To evaluate bariatric surgery access for rural and non-rural patients in the Deep South.
- To compare short- and long-term postoperative outcomes between rural and non-rural patient groups.
- To identify potential disparities in bariatric surgery care and outcomes based on geographic location.
Main Methods:
- Analysis of 3083 primary bariatric surgery referrals from 2015-2023.
- Patient geocoding to stratify by rural status.
- Comparison of clinic attendance, surgery completion, and postoperative outcomes (LOS, readmission, reoperation, leaks, BMI, weight loss) by rurality using multivariable regression.
Main Results:
- Most referrals were non-rural (84%).
- Surgery rates did not differ significantly between rural (46%) and non-rural (49%) patients.
- Postoperative outcomes (LOS, readmission, reoperation, leaks) and initial weight loss were similar. Non-rural patients showed greater long-term BMI reduction and weight loss.
- White patients had shorter LOS and greater weight loss than Black patients.
Conclusions:
- Bariatric surgery access and immediate outcomes are comparable between rural and non-rural populations in the Deep South.
- Longer-term weight loss and BMI reduction favor non-rural patients.
- Racial disparities in LOS and weight loss were observed, with White patients benefiting more.
