Background

Rural bariatric surgery requires special consideration as it is characterized by increased case complexity, late presentation, and lack of access to care. We hypothesize that this leads to barriers in care of complex patients and changes in practice patterns for procedure selection. This study aims to define the characteristics and challenges for rural bariatric care in Southwestern Virginia.

Methods

We identified metropolitan, urban, micropolitan, and rural areas in Virginia by using Centers for Medicaid and Medicare services ambulance density data, census data, and rural-urban commuting area codes. Once delineated, the rural population was then compared to the non-rural population over a one-year period.

Results

622 patients were identified in the rural population compared to 518 in the non-rural population. Patient characteristics such as BMI (48 vs 47) and average weight loss in 30 days (5.34% vs 5.18%) were similar. Obesity related co-morbidities including diabetes (8.68% vs 7.92%), OSA (39.39% vs 34.94%), HTN (50.48% vs 45.75%), and HLD (22.99% vs 20.66%) were more prevalent in the rural population. Unplanned reoperations occurred in 28 v 11 (p = 0.03) and unplanned readmissions in 21 v 19 (p= 0.34) patients in the rural vs non-rural population.

Conclusions

Rural bariatric surgery has unique challenges in presentation, treatment, and outcomes. Similar census-based methods can be applied to other states to define their rural communities. Complication rates remain nominal between the populations. This suggests that bariatric surgery can be performed safely in rural populations.