An Exploration of System-Level Factors and the Geographic Variation in Bariatric Surgery Utilization

There is wide geographic variation in bariatric surgery rates, although higher regional rates of obesity are not correlated with higher rates of surgery. In this study, four system-level factors were explored as contributors to this geographic variation. Geographic utilization rates of bariatric surgery showed no correlation to the number of bariatric surgeons, number of accredited centers, and the percentage of patients with a recent primary care visit. The total number of surgical discharges was weakly correlated with bariatric surgery rates (r = 0.26, p = < 0.001). As surgeon supply, accredited bariatric centers, overall surgical volume, and access to primary care do not appear to heavily influence bariatric surgery rates, future studies are needed to identify additional factors that may explain the underutilization of bariatric surgery.