Background

This study aims to evaluate the relationship between county health ranking (CHR) and short-term primary metabolic and bariatric surgery (MBS) outcomes.

Methods

Data source was 2010-2021 Mayo Clinic Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project databases. Primary cases were identified by current procedural terminology codes 43644, 43645, 43659, 43775. Patient characteristics, procedural data, and 30-day occurrences were collected. Health factor CHR was determined by zip code and stratified into best, middle, and worst terciles. Primary outcome was morbidity. Logistic regression determined the correlation between CHR and morbidity.

Results

4,315 MBS cases were analyzed, with 64%, 27.4% and 8.6% living in the best, middle, and worst tercile of CHR, respectively. Patients in the middle and worst CHR terciles were more commonly older, non-Hispanic black or Hispanic, with pre-existing COPD, coronary intervention, partial dependence, hypertension, therapeutic anticoagulation, dialysis-dependence, IVC filter and have an ASA above three. Middle and worst CHR tercile patients were also more likely to have a sleeve gastrectomy, utilization of the robotic platform and procedure performed by a General Surgeon. Patients in the worst CHR tercile were less likely discharged to home. Sleeve gastrectomy had lower morbidity risk. ASA≥3, dialysis-dependence and COPD independently correlated with morbidity risk (Table). Mortality and morbidity were similar across CHR terciles. There was no significant correlation between CHR terciles and overall morbidity.

Conclusions

Higher risk MBS patients are more likely to be from counties with lower CHR. However, CHR was not associated with 30-day MBS morbidity.