title: Patient and operational factors affecting wait times in a bariatric surgery program in Toronto: a retrospective cohort study.
abstract: BACKGROUND
  Increasing rates of obesity have led to growing demand for bariatric surgery. This has implications for wait times, particularly in publicly funded programs. This study examined the impact of patient and operational factors on wait times in a multidisciplinary bariatric surgery program.
  
  
  METHODS
  A retrospective study was conducted involving patients who were referred to a tertiary care centre (University Health Network, Toronto Western Hospital, Toronto) for bariatric surgery between June 2008 and July 2011. Patient characteristics, dates of clinical assessments and records describing operational changes were collected. Univariable analysis and multivariable log-linear and parametric time-to-event regressions were performed to determine whether patient and operational covariates were associated with the wait time for bariatric surgery (i.e., length of preoperative evaluation).
  
  
  RESULTS
  Of the 1664 patients included in the analysis, 724 underwent surgery with a mean wait time of 440 (standard deviation 198) days and a median wait time of 445 (interquartile range 298-533) days. Wait times ranged from 3 months to 4 years. Univariable and multivariable analyses showed that patients with active substance use (β = 0.3482, p = 0.02) and individuals who entered the program in more recent operational periods (β = 0.2028, p < 0.001) had longer wait times. Additionally, the median time-to-surgery increased over 3 discrete operational periods (characterized by specific program changes related to scheduling and staffing levels, and varying referral rates and defined surgical targets; p < 0.001).
  
  
  CONCLUSIONS
  Some patients could be identified at referral as being at risk for longer wait times. We also found that previous operational decisions significantly increased the wait time in the program since its inception. Therefore, careful consideration must be devoted to process-level decision-making for multistage bariatric surgical programs, because managerial and procedural changes can affect timely access to treatment.
authors.affiliation: Rotman School of Management, University of Toronto, Toronto, Ont.
authors.forename: Adam
authors.initials: A
authors.lastname: Diamant
authors.affiliation: Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Cleghorn
authors.affiliation: Rotman School of Management, University of Toronto, Toronto, Ont.
authors.forename: Joseph
authors.initials: J
authors.lastname: Milner
authors.affiliation: Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.affiliation: Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.affiliation: Division of General Surgery, University Health Network, University of Toronto, Toronto, Ont.
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy