Abstract
BACKGROUND: Increasingly, patients are faced with greater travel distances to undergo bariatric surgery at high-volume centers. OBJECTIVES: This study sought to evaluate the impact of travel distance on access to care and outcomes after bariatric surgery. SETTING: Patients who underwent Roux-en-Y gastric bypass at an academic bariatric surgery center from 1985 to 2004 were examined and stratified by patient travel distance. METHODS: Univariate analyses were performed for preoperative risk factors, 30-day complications, and long-term (10-yr) weight loss between "local," defined as<1 hour of travel time, and "regional," defined as>1 hour of travel time. Survival analysis was performed with Kaplan-Meier and Cox proportional hazards models. RESULTS: A total of 650 patients underwent Roux-en-Y gastric bypass, of whom 316 (48.6%) traveled<1 hour to undergo surgery and 334 (51.4%) traveled>1 hour. Median body mass index was equivalent between the groups (local, 52.9 kg/m(2); regional, 53.2 kg/m(2); P = .76). Patients who traveled longer distances had higher rates of preoperative co-morbidities, including chronic obstructive pulmonary disease, congestive heart failure, diabetes, and sleep apnea (all P<.05). Complications within 30 days of surgery and long-term reduction of excess body mass index were equivalent between groups. Travel time was an independent predictor of risk-adjusted reduced long-term survival (hazard ratio, 1.23, P = .0002). CONCLUSIONS: A majority of patients who underwent bariatric surgery at our center traveled>1 hour. Despite longer travel time for care, 30-day complications and long-term weight loss were equivalent with that of local patients. As expected, patients who lived in close proximity were more likely to adhere to yearly follow-up in surgery clinic. Travel time was an independent predictor of risk-adjusted reduced long-term survival.