Background

We sought to evaluate whether social determinants of health as measured by county health ranking (CHR) was associated with 30-day outcomes following revisional bariatric surgery.

Methods

Bariatric revision/conversion cases were abstracted from the 2010—2021 Mayo Clinic Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project databases. Demographic variables, pre-existing medical conditions, procedural data, and 30-day outcomes were extracted. Health factor CHR was determined from residential zip code and categorized into terciles. Our primary outcome was composite 30-day occurrence. Logistic regression assessed independent association between CHR and morbidity.

Results

The analytic cohort comprised 370 revisional bariatric procedures (n=179 Roux-en-Y gastric bypass, n=122 other open revision, n=46 duodenal switch, n=23 sleeve gastrectomy). Most patients resided in the best or middle tercile of CHR (48.4% best vs. 38.6% middle vs. 13.0% worst). Patient characteristics were similar across CHR terciles, except for a higher proportion of non-White patients in the middle/worst CHR terciles. The worst CHR tercile were more likely to have surgery performed by a general surgeon (33.3% vs. 12.2% (middle) vs. 2.3% (best tercile), p<0.001) and robotic-assisted surgery (39.6% vs. 23.4% (middle) vs. 2.8% (best tercile), p<0.001). Length of stay, disposition, 30-day complications and mortality were comparable across CHR tercile. On logistic regression, CHR was not independently associated with 30-day postoperative occurrence.

Conclusions

Patients requiring revisional bariatric surgery exhibited similar comorbidities regardless of CHR. While specialist training and procedural approach varied, 30-day outcomes were similar across CHR. Further studies are needed to evaluate the impact of CHR on long-term outcomes.