National variations in bariatric surgery utilization

Abstract

Abstract Introduction: Exploring bariatric surgery (BaS) utilization provides initial data in effective treatment allocation. This study analyzes regional and age differences in BaS utilization on a national level. Methods: United States patients undergoing BaS were identified from the 2001 Nationwide Inpatient Sample. Rates of procedures per 100,000 population (ROP) by gender, census region (Northeast[NE], Midwest[MW], South[SO], and West[WE]) and age group were determined using 2000 census data. Rate ratios (RR) were calculated and significance tested via 95% confidence intervals (95%CI) accounting for sampling design using STATA 8.2. Results: From 7,452,727 discharges, 11,108 BaS operations were identified, representing a national cohort of 55,033 patients. ROP were lowest in SO for both sexes across ages. Among women, ROP were highest in MW for ages = 50 years. In men, ROP were highest in NE for ages = 60) in 2.9% of women and 4.4% of men. In women 18, mean age at operation was 16.0 (0.3) years (mean (standard error)) with increased ROP among WE women compared to MW women (RR 11.0, 95% CI 4.4− 27.4). In men >= 60, mean age at operation was 62.8(0.3) years with WE men more likely to undergo BaS than MW men (RR 4.9, 95%CI 3.4 −7.1). Table . Rates of BaS per 100,000 population by gender, census region, and age group Women (n = 46,366; 84%) Men (n = 8,667; 16%) ∗ 18–39 40–49 50–59 ≥60 18–39 40–49 50–59 ≥60 NE 0.5 52.0 73.5 58.3 6.3 0 11.0 20.9 21.2 1.9 MW 0.1 63.7 81.0 56.7 3.9 0.1 7.3 12.7 11.0 0.8 SO 0.3 38.3 50.2 35.3 2.6 0.03 5.6 8.9 8.3 1.1 WE 0.7 51.3 80.8 68.2 7.3 0.2 7.9 16.1 16.5 3.9 ∗ Age category in years. Conclusions: National estimates suggest that BaS rates vary greatly by region and age. Areas with increased rates of non-traditional BaS candidates (age = 60 years) require further evaluation.