Influence of a rural environment on patient access and outcomes for bariatric surgery.
BACKGROUND
Despite a higher rate of obesity in rural populations, there is a 23% decrease in performed bariatric procedures. The influence of a rural environment on surgical outcomes and treatment efficacy is unknown.


METHODS
We retrospectively reviewed all bariatric surgeries performed in a large university hospital in West Virginia from September 2012 to September 2014. Patients were categorized based on their rural-urban commuting area codes. Subject demographic characteristics, insurance provider, type of surgery, completion of program, preoperative body mass index (BMI), percent excess weight loss (%EWL), and percent total weight loss (%TWL) at 6 and 12 months postoperatively, and follow-up appointment attendance were collected. Logistic and linear regression analyses were conducted.


RESULTS
A total of 122 patients were evaluated with 82 receiving surgery. Of these patients, 77 had Roux-en-Y gastric bypass, and 5 had Sleeve Gastrectomy. Nine patients out of 82 were lost to follow-up at 6 months (n = 73), and 12 patients out of 62 were lost to follow-up at 12 months (n = 50). Rural patients were .283 times less likely to receive bariatric surgery, (P = .004). However, this relationship was confounded by insurance provider; after controlling for this variable, the relationship between rural status and surgery completion was nonsignificant (P = .066). Rural status did not predict change in BMI, %EWL, or %TWL at 6 months (P = .738; P = .848; P = .334) or 12 months (P = .902; P = .143; P = .195), or compliance for follow-up appointments (P = .232).


CONCLUSIONS
Rural bariatric patients seem to have decreased success at completing bariatric programs, which is likely confounded by insurance type. Yet, when the rural patient is able to realize the benefits of bariatric surgery, their outcomes are unchanged compared with urban patients. Although the study is limited by sample size, it highlights the need for reducing obstacles for bariatric surgery in an already underserved population, the rural community.
Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
Kristie L
KL
Bergmann
Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
Stephanie J
SJ
Cox
Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia. Electronic address: letabone@hsc.wvu.edu.
Lawrence E
LE
Tabone
D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012424:Rural Population; D013997:Time Factors; D014903:West Virginia / Q000453:epidemiology
Adult; Bariatric surgery; Obesity; Rural