Buckle of the bariatric surgery belt: an analysis of regional disparities in bariatric surgery.

BACKGROUND

Surgical options have emerged as effective treatments to mitigate obesity-associated co-morbidities leading to reduced mortality risk. Despite the benefits of bariatric surgery, a low portion of the eligible population undergoes weight loss procedures.

OBJECTIVES

To determine if regional disparities exist among bariatric patients in the United States and potential effects of any difference SETTING: National Inpatient Sample (NIS).

METHODS

We performed a retrospective, cross-sectional analysis of the NIS database from 2003-2010. We identified 4 regions of the United States; Northeast, Midwest, West, and South. Endpoints included race, payor status, co-morbidities, urban/rural areas, institutional academic status, surgeon, and institutional volume. The sample was analyzed using χ tests, linear regression, and multivariate logistical regression analysis.

RESULTS

A total of 132,342 cases and 636,320 controls were studied. A majority of the study population was female (62.5%) and white (70.0%) with private insurance (42.0%). The highest prevalence of obesity was identified in the South (39.7%) and the lowest in the Midwest (17.1%). The greatest numbers of bariatric procedures are performed in the Northeast (24.4%) compared with the South (13.9%) and Midwest (13%). After controlling for demographic characteristics, the proportion of procedures performed in the Northeast compared with the South (odds ratio .52, confidence interval .40-.66; P<.001) and Midwest (odds ratio .50, confidence interval .33-.75; P<.005) was significant.

CONCLUSION

Significant disparities in bariatric procedures performed were identified in the South and Midwest regions compared with the Northeast. Although the South has a higher prevalence of obesity, thus it could be suggested by outreach programs.