Influence of referral type and sociodemographic factors on completion of bariatric surgery

Abstract

Background

The impact of referral type and socioeconomic status on completion of the bariatric surgery process is not well understood.

Objectives

This study aims to 1) describe how sociodemographic characteristics influence referral type and 2) identify predictors of completion of surgery.

Setting

Large multihospital health care system, including a large academic medical center.

Methods

A retrospective study was performed using data from 2017 to 2022. Patients with a primary care physician within the hospital system who met criteria for bariatric surgery were included. The primary outcome was completion of bariatric surgery; the predictor was referral type (i.e., physician referral versus patient self-referral). Bivariate analysis and multivariable logistic regression were performed.

Results

Of 133,882 overall patients who met criteria for bariatric surgery, 41,387 had physician referrals for bariatric surgery or obesity medicine, 4702 self-referred, and 2740 underwent surgery. Patients who were Black, Hispanic, Medicaid insured, or in the most socially vulnerable zip codes were more likely to be self-referred (all P < .01). In a multivariable logistic regression, self-referred patients were more likely to undergo surgery (2.22 [1.82, 2.73]). Hispanic patients, while less likely to be referred overall, were more likely to undergo surgery if they were referred (1.29 [1.13, 1.47]). Patients with Medicare, Medicaid, and who were more socially vulnerable had lower odds of undergoing surgery.

Conclusions

Underserved groups are less likely to be referred by physicians for bariatric surgery. However, those patients who do self-refer are more likely to proceed to surgery, demonstrating the barrier is one of access not motivation.