Rurality and Metabolic and Bariatric Surgery Access and Outcomes in the Deep South

Bariatric surgery is effective in treating obesity with excellent short- and long-term outcomes. However, bariatric surgery remains underutilized, particularly in the Deep South. Rurality is associated with poor surgical outcomes and access to care. This study sought to evaluate access to and outcomes following bariatric surgery for rural and non-rural patients in the Deep South.

All patients referred for primary bariatric surgery from 2015 to 2023 were identified from a single institutional database (n = 3083). Patients were geocoded and stratified by rural status. Clinic attendance, completion of surgery, and postoperative outcomes were compared by rurality. Multivariable regression models were used to assess short- and long-term postoperative outcomes.

Most patients were non-rural (84%, n = 2596). Among clinic attendees (n = 2287), there was no difference in the rates of bariatric surgery by rural versus non-rural status, with 49% and 46%, respectively (P = 0.30). Postoperative LOS, 30-d readmission rate, reoperation rate, and leak rates were not statistically different between the populations. Change in body mass index (BMI), percent excess weight loss, and percent total body weight loss were not significantly different for rural and non-rural patients. However, with multivariable linear regressions, non-rural patients experienced a greater decrease in BMI at 3 y and a greater percent total body weight loss at 6 mo and 3 y. Additionally, White patients were found to have had a 15% shorter mean LOS and experienced greater weight loss at each recorded time point.

Our study demonstrated that most bariatric surgery referrals were for non-rural patients, despite serving a largely rural population. No significant differences in outcomes were found based on rurality. Incidentally, White patients sustained more weight loss than Black patients and had a reduction in LOS.