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Surgical Endoscopy

, Volume 33, Issue 4, pp 1167–1173 | Cite as

The effect of distance on short-term outcomes in a regionalized, publicly funded bariatric surgery model

  • Aristithes G. Doumouras
  • Fady Saleh
  • Dennis HongEmail author
Article

Abstract

Background

While high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission.

Methods

This was a retrospective study of all adults, aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario. Main outcomes included 30-day complication rates and readmission. Multivariable logistic regression was used to examine the impact of distance from patients’ primary residence to their bariatric COE on patient outcomes and readmissions.

Results

Five thousand and seven patients were identified, two-thirds residing within 100 km of a COE with a mean distance of 117.2 km. The majority of patients did not reside within a Local Integrated Health Network (LHIN) that contained a COE, while 18.3% of patients lived in rural areas. Using multivariable adjustment, for every 10 km increase from the COE where surgery was performed, the Odds Ratio (OR) for complications was 1.00 [95% Confidence Interval (CI) 0.99–1.01; P = 0.747]. Additionally, both residing in a LHIN without a COE, OR 1.10 (95% CI 0.87–1.40; P = 0.434), and rural status, OR 0.97 (95% CI 0.77–1.23; P = 0.821) showed no increase in risk of complication. Similarly, further distances did not influence rate of readmission, OR 0.99 (95% CI 0.98–1.00; P = 0.077) nor did rural status OR 1.31 (95% CI 0.97–1.76; P = 0.076).

Conclusion

The COE model, where a few centers in high population areas service a large geographic region, is adequate in ensuring patients that live further away receive appropriate short-term care.

Keywords

Bariatric surgery Distance Regionalization Outcomes Complications 

Notes

Compliance with ethical standards

Disclosures

Drs. Aristithes Doumouras, Fady Saleh, Dennis Hong have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General SurgerySt. Joseph’s HealthcareHamiltonCanada
  2. 2.Department of SurgeryMcMaster UniversityHamiltonCanada
  3. 3.Division of General SurgerySt. Joseph’s HealthcareHamiltonCanada

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