SSAT - Patient Travel and Choice Making in Bariatric Surgery

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Patient Travel and Choice Making in Bariatric Surgery
Zhi Ven Fong^*, Elan R. Witkowski, Keith D. Lillemoe, Matthew Hutter, David C. Chang
General Surgery, Massachusetts General Hospital, Boston, MA

Introduction: Bariatric Center of Excellence (COE) was a program developed to highlight centers that provide excellent quality of care and maintaining a minimum volume threshold of bariatric cases. The COE program aims at informing patients when selecting hospitals for their care. How patients truly select hospitals for bariatric care remains unclear.
Methods: The California’s statewide database was used to identify 100% of patients who received bariatric surgery from 1995-2009. Straight-line distances were calculated between patient home ZIP codes and hospital addresses. Bypassed hospitals were defined as those that performed bariatric surgery and were closer to patients’ residence ZIP code than their destination hospital.
Results: A total of 133,599 patients underwent bariatric surgery. Only 14,671 (10.9%) patients underwent bariatric surgery at the nearest providing hospital, travelling a median of 4.4 miles (IQR 2.2-11.6 miles). Conversely, 118,298 (89.1%) patients bypassed the closest bariatric hospital, bypassing a median of 10 (IQR 4-35) hospitals and travelling a median of 29.2 miles (IQR 12.7-70.8 miles). Of patients who received care at a COE, only 9,600 (38.1%) patients did so at the nearest COE. Among patients who did not present to a COE, 69.0% had bypassed at least one COE on their way to the hospital. Additionally, 98,599 (82.9%) patients bypass a higher volume center, and 39,085 (32.9%), a hospital with lower mortality to get to their destination hospital.
Conclusion: The majority of patients traveled beyond their nearest hospital and COE for their bariatric care. Hospital COE status, volume and mortality rates did not appear to impact hospital choice.

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