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

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.