Waiting time for bariatric and metabolic surgery in the Brazilian public health system and comorbidities: what is the impact?Background: Obesity is a multifactorial disease with a high prevalence that leads to several comorbidities, posing significant challenges for healthcare systems. Bariatric and metabolic surgery (BMS) has been established as the most effective treatment for patients with obesity; however, in Brazil, limited access remains a critical barrier.
Aims: This study aimed to evaluate the clinical, demographic, and metabolic characteristics of patients with obesity undergoing BMS in the Brazilian Unified Health System and to analyze the relationship between waiting time and comorbidities.
Methods: A retrospective cohort study was conducted involving 1,000 patients with obesity who underwent treatment between July 2022 and June 2024. Clinical, anthropometric, and laboratory variables were analyzed using regression analysis and statistical tests to assess the association between waiting time and comorbidities.
Results: A significant correlation was found between prolonged waiting time and an increased number of comorbidities (R²=0.686; p<0.001). Furthermore, the number of comorbidities explained 60% of the variability in waiting time (R²=0.600; p<0.001), with a mean increase of 1.92 years for each additional comorbidity (95%CI 1.82–2.02). Patients on the waiting list for more than 10 years had higher rates of hypertension, type 2 diabetes, and dyslipidemia. Waiting time also had an impact on some metabolic syndrome parameters, including glycated hemoglobin (Hb1Ac) (r=+680, p=0.031), low-density lipoprotein (LDL) (r=+640, p=0.044), and total cholesterol (r=+830, p=0.008).
Conclusions: Prolonged waiting time for bariatric and metabolic surgery is associated with an increased burden of metabolic comorbidities and their consequences.
Headings:
Bariatric surgery; Metabolic syndrome; Public health; Demography; Obesity
Early intervention is crucial for achieving better outcomes in most diseases. Similarly, early bariatric and metabolic surgery in patients with obesity can lead to improved cardiovascular outcomes, including reduced mortality and preventable morbidity.
A significant correlation was found between prolonged waiting time and an increased number of comorbidities (R²=0.686; p<0.001). Furthermore, the number of comorbidities explained 60% of the variability (R²=0.600; p<0.001), with a mean increase of 1.92 years for each additional comorbidity (95%CI 1.82–2.02).
Prolonged waiting time for bariatric and metabolic surgery is associated with an increased burden of metabolic comorbidities and their consequences.
CENTRAL MESSAGE Bariatric and metabolic surgery (BMS) has been shown to be effective and safe in ameliorated comorbidities. The medical literature supports the notion that early intervention is crucial for achieving better outcomes in most diseases. Similarly, early BMS in patients with obesity can lead to improved cardiovascular outcomes, including reduced mortality and a lower incidence of cardiovascular events. BMS has also been shown to have renoprotective effects, potentially helping to prevent renal failure and significantly reducing the risk of progression from chronic kidney disease to kidney failure. Furthermore, BMS is associated with a 49.2% reduction in the hazard rate of death compared to usual care, with a median increase in life expectancy of 6.1 years.
PERSPECTIVES Prolonged waiting time for bariatric and metabolic surgery was associated with an increased number of comorbidities and their complications, particularly hypertension, type 2 diabetes, and dyslipidemia. Similarly, laboratory parameters associated with metabolic syndrome, such as glycated hemoglobin (HbA1c), low density protein (LDL), and total cholesterol, also worsened significantly with delayed bariatric surgery.
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