Bariatric Surgery: Health Delayed Is Health Denied

Waiting times for bariatric surgery have nearly doubled in a decade. That’s one of the findings from a study that will soon appear in Annals of Surgery. Health insurers drive most of these delays according to the authors. But those longer wait times apparently do nothing to improve the outcomes or prevent complications. The result is simply better health delayed.

Wide Variation

These data come from the Michigan Bariatric Surgery Collaborative. Researchers examined 60,791 patient records spanning a decade. In 2006, the average wait time was 86 days. But by 2016, that average rose to 159 days. By looking at quartiles of wait times, investigators dug into some of the differences between patients with the shortest and longest waits.

Among the most fortunate quarter of patients – those with the shortest waits – the wait was 67 days or less. But at the other extreme, the wait was three times longer – a minimum of 204 days. The biggest factor by far was insurance. The odds of a long wait tripled for Medicaid patients. Other factors included race and other medical conditions. White patients didn’t wait as long. Patients with a smoking history, sleep apnea, high cholesterol, or a psychological disorder waited longer.

But it’s important to note that this extra waiting made no difference in outcomes. Waiting did nothing to reduce the odds of a complication or improve the odds of better weight loss.

Pre-Operative Weight Loss Requirements

One of the factors responsible for these delays would be a health plan that requires six or twelve months of a supervised weight loss program before surgery.  Medicaid requires this, despite the fact that no evidence suggests any benefit for such a requirement. The only rational requirement might be a short-term regimen to reduce fat around the liver.

It’s time to re-examine policies that delay this surgery for people who clearly need it. Health delayed is health denied.

Click here to read the study and here for further perspective.

Waiting, photograph © ehpien / flickr

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July 12, 2018