Background

The impact of referral type and socioeconomic status on completion of the bariatric surgery process is not well understood. This study aims to 1) describe how sociodemographic characteristics influence referral type and 2) identify predictors of completion of bariatric surgery.

Methods

A retrospective study was performed using data from a multi-hospital healthcare system from 2017-2022. Patients with a primary care physician within the system who met criteria for bariatric surgery were included. The primary outcome was completion of bariatric surgery, the predictor was referral type. 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, 4,702 self-referred and 2,740 underwent surgery. Patients who self-referred were more likely to be Black or Hispanic compared to patients with physician referrals and were also more likely to by insured by Medicaid and live in the lowest quartile of socially vulnerable zip codes (all p<0.001). In a multivariable logistic regression, self-referred patients were more likely to undergo surgery (2.22 [1.82,2.73], p<0.001). 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], p<0.001). Patients with Medicare, Medicaid, and who were more socially vulnerable had lower odds of undergoing surgery.

Conclusions

Underserved groups are more likely to self-refer, and less likely to undergo surgery. Those who do self-refer are more likely to proceed to surgery, demonstrating the barrier is one of access not motivation.