title: Patient travel for bariatric surgery: does distance matter?
abstract: BACKGROUND
  Increasingly, patients are faced with greater travel distances to undergo bariatric surgery at high-volume centers.
  
  
  OBJECTIVE
  This study sought to evaluate the impact of travel distance on access to care and outcomes after bariatric surgery.
  
  
  METHODS
  Patients who underwent Roux-en-Y gastric bypass at an academic bariatric surgery center from 1985 to 2004 were examined and stratified by patient travel distance.
  
  
  METHODS
  Univariate analyses were performed for preoperative risk factors, 30-day complications, and long-term (10-yr) weight loss between "local," defined as<1 hour of travel time, and "regional," defined as>1 hour of travel time. Survival analysis was performed with Kaplan-Meier and Cox proportional hazards models.
  
  
  RESULTS
  A total of 650 patients underwent Roux-en-Y gastric bypass, of whom 316 (48.6%) traveled<1 hour to undergo surgery and 334 (51.4%) traveled>1 hour. Median body mass index was equivalent between the groups (local, 52.9 kg/m2; regional, 53.2 kg/m2; P = .76). Patients who traveled longer distances had higher rates of preoperative co-morbidities, including chronic obstructive pulmonary disease, congestive heart failure, diabetes, and sleep apnea (all P<.05). Complications within 30 days of surgery and long-term reduction of excess body mass index were equivalent between groups. Travel time was an independent predictor of risk-adjusted reduced long-term survival (hazard ratio, 1.23, P = .0002).
  
  
  CONCLUSIONS
  A majority of patients who underwent bariatric surgery at our center traveled>1 hour. Despite longer travel time for care, 30-day complications and long-term weight loss were equivalent with that of local patients. As expected, patients who lived in close proximity were more likely to adhere to yearly follow-up in surgery clinic. Travel time was an independent predictor of risk-adjusted reduced long-term survival.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Mehaffey
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Michaels
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Mullen
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Max O
authors.initials: MO
authors.lastname: Meneveau
authors.affiliation: Department of Surgery, Billings Clinic, Billings, Montana.
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: PTH2F@virginia.edu.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Access to care; Bariatric; Center of excellence; Roux-en-Y gastric bypass (RYGB); Travel distance