Bariatric Surgery: Improving Access without Compromising Outcomes

Introduction: Bariatric surgery preoperative workup mandates many multidisciplinary visits demanding patient’s sacrifice in time and travel. Due to the COVID pandemic, our institution’s entire bariatric clinic transitioned to a telemedicine model. The objective of this study was to determine how this shift impacted access and outcomes.  

Methods: We studied adults who underwent gastric bypass or sleeve gastrectomy at our institution between 2018-2022. We analyzed the impact of telemedicine on age, race/ethnicity, gender, insurance type, days from consultation to surgery, length of stay, surgical procedures, BMI, and complications. Statistical analyses were conducted using χ2 tests for categorical variables and t-test for continuous variables as well as logistic regression.

Results: Of 794 patients, 566 (71.3%) received in-person care while 228 (28.7%) received telemedicine consultations. There was no significant difference between race, ethnicity or gender. The average duration from the consultation to surgery was longer (p<0.001) for in-person (551.1 days) compared to telemedicine (375.8 days). The mean preoperative BMI was higher for the in-person cohort (45.5; vs. 43.9; p<0.001).

The average length of stay was longer (p<0.001) in the in-person group compared to the telemedicine (1.9 days vs. 1.2 days). For 30-day readmission rates, we observed 2.5% for in-person visits versus 0.8% for telemedicine (p=0.14) and for 30-day emergency department visit rates, we found 12.8% for in-person and 10.9% for telemedicine (p=0.45).

Conclusion: Bariatric surgery remains underutilized. When comparing telemedicine to an in-person model, we found shorter time to surgery, shorter length of stay and non-inferiority in outcomes. Telemedicine may improve access for patients seeking bariatric surgery.