Skip to main content
SpringerLink
Log in

A Longitudinal Analysis of Wait Times for Bariatric Surgery in a Publicly Funded, Regionalized Bariatric Care System

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery is proven to be the most effective strategy for management of obesity and its related comorbidities. However, in Canada, patients awaiting bariatric surgery can be subjected to prolonged wait times, thereby subjecting them to increased morbidity and mortality, as well as decreased psychosocial well-being.

Objective

To assess the factors associated with prolonged wait times for bariatric surgery within a publicly funded, provincial bariatric network.

Methods

This was a retrospective population-based study of all patients aged > 18 years who were referred for bariatric surgery from April 2009 to May 2015 using linked administrative databases to capture patient demographic data, socioeconomic variables, healthcare utilization, and institutional factors. The main outcome of interest was a wait time greater than 18 months. Multivariate logistic regression modeling was used to estimate odds ratios (OR) and 95% confidence intervals (CI).

Results

A total of 18,854 patients underwent bariatric surgery from April 2009 to December 2016, of which 2407 patients experienced wait times of > 18 months. On average, yearly wait times have increased for patients receiving surgery with wait times of 10.98 months (SD 5.48) in 2010 and 13.09 (SD 6.69) in 2016 (p < 0.001). Increasing age (OR 1.12, 95% CI 1.05–1.19, p = 0.0004), BMI (OR 1.08, 95% CI 1.04–1.11, p < 0.001), and male gender (OR 1.47, 95% CI 1.28–1.70, p < 0.001) were significantly associated with increased bariatric surgery wait times. Additionally, smoking status (OR 1.46, 95% CI 1.09–1.97, p = 0.0118) and obesity-related comorbidities particularly diabetes (OR 1.29, 95% CI 1.14–1.44, p < 0.001) and heart failure (OR 1.72, 95% CI 1.43–2.07, p < 0.001) were correlated with prolonged wait times for surgery. Socioeconomic variables including disability (OR 1.64, 95% CI 1.38–1.92, p < 0.001) and immigration status (OR 1.35, 95% 1.11–1.64, p = 0.003) were correlated with increased odds of longer wait times, as were regions with regionalized assessment and treatment centres (RATC) when referenced against centers of excellence (COEs) in number of days added with 20.45 (95% CI 13.20–27.70, p < 0.001).

Conclusion

Wait times for bariatric surgery in a publicly funded, regionalized bariatric program are influenced by certain patient characteristics, socioeconomic variables, and institutional factors. This warrants further intervention and study to help improve these inequities when encountering potentially vulnerable populations awaiting bariatric surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ng M, Fleming T, Robinson M, et al. Global, regional and national prevalence of overweight and obesity in children and adults 1980–2013: a systematic analysis. Lancet. 2014;384:766–81.

    Article  Google Scholar 

  2. Statistics Canada. Overweight and obese adults (self-reported), 2014. 2014.https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14185-eng.htm

  3. Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149:1323–9.

    Article  Google Scholar 

  4. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery a systematic review and meta-analysis. JAMA. 2004;292:1724–8.

    Article  CAS  Google Scholar 

  5. Borisenko O, Adam D, Funch-Jensen P, et al. Bariatric surgery can lead to net cost saving to health care systems: results from a comprehensive European decision analytic model. Obes Surg. 2015;25:1559–68.

    Article  Google Scholar 

  6. Hollenbeak CS, Rogers AM, Barrus B, et al. Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery. 2008;144:736–43.

    Article  Google Scholar 

  7. Zevin B, Aggarwal R, Grantcharov TP. Volume-outcome association in bariatric surgery: a systematic review. Ann Surg. 2012;256:60–71.

    Article  Google Scholar 

  8. Carbonell AM, Lincourt AE, Matthews BD, et al. National study of the effect of patient and hospital characteristics on bariatric surgery outcomes. Am Surg. 2005;71:308–14.

    PubMed  Google Scholar 

  9. Doumouras AG, Saleh F, Anvari S, et al. Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg. 2018 Mar;267(3):489–94.

    Article  Google Scholar 

  10. Doumouras AG, Saleh F, Anvari S, et al. A longitudinal analysis of short-term costs and outcomes in a regionalized center of excellence bariatric care system. Obes Surg. 2017 Nov;27(11):2811–7.

    Article  Google Scholar 

  11. Christou NV, Efthimiou E. Bariatric surgery waiting times in Canada. Can J Surg. 2009;52:229–34.

    PubMed  PubMed Central  Google Scholar 

  12. Sutherland JM, Liu G, Crump RT, et al. Waiting for surgery: is waiting bad for anyone or everyone? Hernia. 2017;21:933–40.

    Article  CAS  Google Scholar 

  13. Padwal RS, Majumdar SR, Klarenbach S, et al. Health status, quality of life, and satisfaction of patients awaiting multidisciplinary bariatric care. BMC Health Serv Res. 2012;12

  14. Lakoff JM, Ellsmere J, Ransom T. Cause of death in patients awaiting bariatric surgery. Can J Surg. 2015;58(1):15–8.

    Article  Google Scholar 

  15. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23. discussion 423–4

    Article  Google Scholar 

  16. Reges O, Greenland P, Dicker D, et al. Association of bariatric surgery using laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy vs usual care obesity management with all-cause mortality. JAMA. 2018;319(3):279–90. https://doi.org/10.1001/jama.2017.20513.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Doumouras AG, Anvari S, Breau R, et al. The effect of an online referral system on referrals to bariatric surgery. Surg Endosc. 2017;31(12):5127–34.

    Article  Google Scholar 

  18. Gregory DM, Newhook JT, Twells LK. Patients’ perceptions of waiting for bariatric surgery: a qualitative study. Int J Equity Health. 2013; 12(86):

  19. Martin M, Beekley A, Kjorstad R, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surgr Obes Relat Dis. 2010;6:8–15.

    Article  Google Scholar 

  20. Stanford FC, Jones DB, Schneider BE, et al. Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis. Surg Endosc. 2015;29:2794–00.

    Article  Google Scholar 

  21. Wallace AE, Young-Xu Y, Hartley D, et al. Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg. 2010;20:1354–60.

    Article  Google Scholar 

  22. Diamant A, Milner J, Cleghorn M, et al. Analysis of patient attrition in a publicly funded bariatric surgery program. J Am Coll Surg. 2014; https://doi.org/10.1016/j.jamcollsurg.2014.08.003.

  23. Taylor T, Wang Y, Rogerson W, et al. Attrition after acceptance onto a publicly funded bariatric surgery program. Obes Surg. 2018;28:2500–7.

    Article  Google Scholar 

  24. Hajizadeh M. Does socioeconomic status affect lengthy wait time in Canada? Evidence from Canadian Community Health Surveys. Eur J Health Econ. 2018;19:369–83.

    Article  Google Scholar 

  25. Shortt SED, Shaw RA. Equity in Canadian health care: Does socioeconomic status affect waiting times for elective surgery? CMAJ. 2003;168(4):413–6.

    PubMed  PubMed Central  Google Scholar 

  26. Sutherland JM, Kurzawa Z, Karimuddin A, et al. Wait lists and adult general surgery: is there a socioeconomic dimension in Canada. BMC Health Services Research. 2019;19(161).

Download references

Acknowledgment

Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information.

Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).

Author information

Authors and Affiliations

  1. Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Aristithes G. Doumouras, Aneetinder Mann, Scott Gmora, Mehran Anvari & Dennis Hong

  2. Division of General Surgery, St. Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada

    Aristithes G. Doumouras, Scott Gmora, Mehran Anvari & Dennis Hong

  3. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Samantha Albacete

Authors
  1. Aristithes G. Doumouras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samantha Albacete
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aneetinder Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott Gmora
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehran Anvari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dennis Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dennis Hong.

Ethics declarations

The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a Research Ethics Board.

Conflict of Interest

The authors declare that they have no conflict of interest.

Disclaimer

The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Additional information

This data has not been presented previously.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doumouras, A.G., Albacete, S., Mann, A. et al. A Longitudinal Analysis of Wait Times for Bariatric Surgery in a Publicly Funded, Regionalized Bariatric Care System. OBES SURG 30, 961–968 (2020). https://doi.org/10.1007/s11695-019-04259-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04259-8

Keywords

Search

Navigation