Why bariatric surgery wait times have nearly doubled in 10 years

July 30, 2018

Diagnosed with type 2 diabetes, high cholesterol and borderline high blood pressure, Dana Hayes pursued bariatric surgery in hopes of living a healthier life.

"I struggled with weight my whole life, but this was a place I'd never been before," says Hayes, 30, a hairdresser and mother of four. "Diabetes was the final straw."

She waited five months for surgery after her first clinic appointment.

That wait is not uncommon: Eligible patients are increasingly facing longer waits for operations proven to help them safely lose weight that endangers their health, according to a new study published in the Annals of Surgery.

In the first multi-institutional look at bariatric surgery wait times in the United States, surgeons examined data collected by the Michigan Bariatric Surgery Collaborative (MBSC) on 60,791 patients who had bariatric surgery in Michigan.

In 2006, patients typically had their bariatric surgery 86 days after their first clinic visit. By 2016, wait times had nearly doubled to 159 days.

"Prolonged wait times can be discouraging and increase the chance that patients will drop their pursuit of surgery," says study author Oliver Varban, M.D., an assistant professor of surgery at the University of Michigan and director of the Adult Bariatric Surgery Program. He also performed Hayes' surgery.

Because more surgeons have begun performing bariatric surgery in Michigan over the past decade, finding an available doctor had minimal impact on scheduling, authors affirmed.

Why surgical delays occur

Researchers used the data to create two study groups: a shorter wait time group that had a median wait of 67 days and a longer wait time group that waited 204 days or more for surgery.

After one year, patients in the longer wait time group had lost 56.6 pounds compared with the shorter wait time group in which average weight loss was 58.9 pounds.

Patients with complex medical histories enrolled in Medicaid experienced the longest delays. Nonwhite patients also waited longer, but in Michigan they are more often enrolled in Medicaid.

Smokers and patients with high cholesterol or psychological disorders also had longer wait times for bariatric surgery.

But there was no major effect on well-being: Among all recipients, serious complications occurred in just 2 percent of patients in the first month after surgery.

So why do patients face longer wait times to receive bariatric surgery compared with surgeries to treat other life-threatening conditions such as cancer and heart disease?

One big reason: Many insurance companies require them to lose weight before the surgery, even though there's no data or evidence to prove preoperative weight loss affects long-term success.

Some insurers, including Medicaid, want documentation of supervised diet attempts. Patients may lose some weight that improves their health conditions, but the benefits won't last unless the patients can keep the weight off.

"Showing that patients waiting longer are not experiencing fewer complications or better comorbidity resolution than those with shorter wait times argues for streamlining the preoperative optimization process and against insurance-mandated weight-loss documentation," says U-M general surgery resident Rafael Alvarez, M.D., lead author of the study.

Insurer mandates can result in a delay in care, study authors say, and such policies should be re-examined considering their unclear benefit to patients.

A push for timely intervention

The study team members recognize that their data cannot gauge attitudes or second thoughts.

Cautious doctors may overestimate surgery risk, and patients can get cold feet and intentionally delay surgery. And the study was not able to measure the availability of other specialists, such as registered dietitians, who are needed to guide patients through a successful health transformation.

Even without the practice-specific details, the work led by U-M surgeons is the most robust examination of bariatric surgery wait times in the U.S.

About 95 percent of patients undergoing bariatric surgery in Michigan are enrolled in the MBSC registry used for the study.

Surgeons across the state share information about their cases via MBSC with the intent of recognizing practice trends and patient outcomes in a way that a single doctor or even a hospital would be able to do on their own -- namely whether suitable patients receive bariatric surgery in a timely fashion.

After a onetime weight of 285 pounds, Hayes has lost 30 pounds in a little more than two months after gastric sleeve surgery. Her recovery was event-free; she returned to work in two weeks.

The steady decline in weight has given Hayes a welcome boost of energy for work and family life. Her blood sugar levels are normal.

And Hayes has talked to a dietitian about how to get adequate nutrition now that she is consuming less food.

"My only regret," she says, "is that I didn't do it sooner."

Michigan Medicine - University of Michigan

Related Bariatric Surgery Articles from Brightsurf:

Statement on metabolic and bariatric surgery during COVID-19 pandemic
The American Society for Metabolic and Bariatric Surgery (ASMBS), the leading organization of bariatric surgeons and integrated health professionals in the nation, declared metabolic and bariatric surgery 'medically necessary and the best treatment for those with the life-threatening and life-limiting disease of severe obesity' and called for the safe and rapid resumption of procedures, which have been largely postponed along with other surgeries deemed elective amid the COVID-19 pandemic.

Examining association between weight loss before bariatric surgery, risk of death after surgery
Researchers looked at whether a patient's body weight and weight loss before bariatric surgery were associated with risk of death within 30 days after surgery using data from nearly 500,000 patients in the US and Canada.

Bariatric surgery effective against early-onset obesity too
Surgical treatment of obesity is as effective for individuals who developed the disorder early, by the age of 20, as for those who have developed obesity later in life, a study from the University of Gothenburg shows.

Lower risk for malignant melanoma after bariatric surgery
Bariatric surgery is associated with a distinct reduction in skin-cancer risk, a study shows.

Study shows risks for additional procedures after bariatric surgery
Which of the two most common bariatric surgeries -- gastric sleeve or gastric bypass -- has the highest subsequent risk of additional operations or procedures?

Studies continue to highlight benefits of bariatric surgery in teens
Children's Colorado researchers and their colleagues found that musculoskeletal pain, physical function and quality of life in adolescents significantly improves and is maintained three years after bariatric surgery.

Bariatric surgery may not lead to lower health care costs
Despite helping to bring about improved survival and significant weight loss, bariatric surgery may not lead to lower health care costs in the long term, says a Veterans Affairs study.

Bariatric surgery is safe for teens with morbid obesity
Bariatric surgery is safe and, in many cases, beneficial for teenagers with morbid obesity who would otherwise face a heightened risk of developing severe health problems, including heart disease and stroke, according to a new study from Penn Medicine and the Children's Hospital of Philadelphia (CHOP).

Criteria for bariatric surgery should consider more than just patient's weight
More than one-third of Americans are obese, and while more than 250,000 bariatric surgeries are performed annually in the United States, experts at The Ohio State University Wexner Medical Center and 45 worldwide scientific and medical societies say surgery should be an option for many more patients.

Bariatric surgery can be safe and effective for adolescents
Pediatricians are often reluctant to recommend bariatric surgery for teen-agers, but a Rutgers-led study concludes it is a justifiable treatment for adolescents with persistent extreme obesity if they can maintain a healthy lifestyle afterward.

Read More: Bariatric Surgery News and Bariatric Surgery Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.