Bergmann Kristie L, Cox Stephanie J, Tabone Lawrence E
Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia.
Surg Obes Relat Dis. 2017 Apr;13(4):632-636. doi: 10.1016/j.soard.2016.11.009. Epub 2016 Nov 11.
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.
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.
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).
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.
尽管农村人口肥胖率较高，但接受减肥手术的比例却下降了23%。农村环境对手术结果和治疗效果的影响尚不清楚。
我们回顾性分析了2012年9月至2014年9月在西弗吉尼亚州一家大型大学医院进行的所有减肥手术。根据患者的城乡通勤区号进行分类。收集患者的人口统计学特征、保险提供商、手术类型、项目完成情况、术前体重指数（BMI）、术后6个月和12个月的超重体重减轻百分比（%EWL）、总体重减轻百分比（%TWL）以及随访预约出席情况。进行逻辑回归和线性回归分析。
共评估了122例患者，其中82例接受了手术。在这些患者中，77例行Roux-en-Y胃旁路术，5例行袖状胃切除术。82例患者中有9例在6个月时失访（n = 73），62例患者中有12例在12个月时失访（n = 50）。农村患者接受减肥手术的可能性比城市患者低0.283倍（P = 0.004）。然而，这种关系因保险提供商而混淆；在控制该变量后，农村状态与手术完成之间的关系不显著（P = 0.066）。农村状态在6个月（P = 0.738；P = 0.848；P = 0.334）或12个月（P = 0.902；P = 0.143；P = 0.195）时不能预测BMI、%EWL或%TWL的变化，也不能预测随访预约的依从性（P = 0.232）。
农村减肥患者完成减肥项目的成功率似乎较低，这可能与保险类型有关。然而，当农村患者能够实现减肥手术的益处时，他们与城市患者相比结果并无差异。尽管该研究受样本量限制，但它凸显了在农村社区这一医疗服务本就不足的人群中减少减肥手术障碍的必要性。
