Feasibility and short-term results of bariatric destination care: experience from a single Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited center.

Background: Employers are adopting "destination care" (DC) to manage employee health care costs and assure quality. Providing bariatric surgical care in centers remote from the patient's home raises legitimate safety and follow-up concerns.

Objectives: To evaluate outcomes and complications of patients traveling for an initial bariatric procedure as part of a workplace health care benefit program compared to those locally referred. Secondary outcomes were to describe DC program patient satisfaction, 1-year follow-up, and cost.

Setting: Single center, tertiary referral, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited bariatric surgery center, United States.

Methods: A retrospective review of a prospectively maintained database was conducted of DC (n = 63) and non-DC patients (n = 632) from December 2016 through July 2018.

Results: Sixty-three DC patients had either sleeve gastrectomy (SG) (36.5%; n = 23) or Roux-en-Y gastric bypass (63.5%; n = 40), with a higher ratio of SG procedure selection compared to locals. Despite DC patients being of higher acuity (age, body mass index, comorbidities, number of home medications, higher American Society of Anesthesiologists classification, decreased functional status), there were no statistically significant differences in 30-day complication (4.8% DC vs 8.2% non-DC; P = .464), readmission (4.8% DC vs 4.4% non-DC; P = .755), or mortality (0%). Weight loss was comparable. DC patients reported higher satisfaction. All DC patients had successful video conference follow-up at 6 months and 82.5% (n = 52) at 1 year. Of those that did not, 63% (n = 7) had follow-up data provided by their primary care physicians or followed-up at 2 years.

Conclusions: A thoughtfully designed national DC program can be both feasible and effective, offering short-term outcomes comparable to those of locally treated patients in a high-volume, MBSAQIP-accredited bariatric center. However, these findings should be interpreted with caution, as the study was not powered to detect small differences. Moreover, the short follow-up period and single-institution design may limit the generalizability of the results. Successful implementation of such a program requires close coordination among providers, patients, and payers.