Distressed Communities Associated with Worse Long-Term Follow-Up after Gastric Bypass

Abstract

INTRODUCTION: Distressed Community Index (DCI) is a composite measure of community economic well-being. This study evaluates the differences in bariatric surgery outcomes between low-tier (LT) and high-tier (HT) DCI. METHODS: Consecutive patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) were geocoded into HT (mid, comfortable, and prosperous communities) and LT (distressed and at-risk communities). RESULTS: Of 142 consecutive patients who underwent LRYGB, 79% were women and 81% were Caucasian. Preoperative age was 44.2 ± 12.0 years, and BMI 44.3 ± 7.3 kg/m2 with no difference in mean age, BMI, or prevalence of race or gender between DCI tiers. Overall, 76% of patients had private insurance, and there were more Medicaid patients in LT group (13.3% vs 3.8%, p = 0.048). There were no differences between LT and HT in wait time to operation (23.7 ± 42.7 months vs 17.8 ± 28.7 months, p = 0.123), operative time (232 ± 85 minutes vs 213 ± 67 minutes, p = 0.158), all-cause complication (18.6% vs 22.4%, p = 0.772), or % excess weight loss at 6 months (57.8 ± 17.1% vs 56.4 ± 16.6%, p = 0.612) and 12 months (71.4 ± 21.1% vs 70.7 ± 19.8%, p = 0.654). LT was associated with poorer 1-year follow-up on both Mann-Whitney U (39.5% vs 59.6%, p = 0.04) and multivariate analyses (adjusted odds ratio 0.79 [CI 0.72–0.87]). CONCLUSION: Patients from distressed and at-risk communities had similar postoperative outcomes to high-tier DCI patients but were less likely to maintain postsurgical follow-up. Loss to follow-up is associated with worse long-term outcomes after LRYGB; therefore, attention must be paid to LT DCI patients to identify and mitigate barriers to follow-up.