Introduction Bariatric surgery is the most effective treatment for severe obesity, yet significant socioeconomic disparities in access and outcomes persist, especially in disadvantaged communities. Neighborhood socioeconomic status (nSES) influences healthcare utilization, complication rates, and recovery, but its impact within state-specific reimbursement models remains understudied.

Objective This study examines whether nSES, measured by the Distressed Communities Index (DCI), is independently associated with prolonged hospital stays and higher readmission rates after bariatric surgery. It also evaluates the interaction between race/ethnicity and nSES, to assess disparities in post-surgical outcomes.

Methodology A retrospective cohort study was conducted using Maryland State Inpatient Databases (SID) from 2018 to 2020. The study population included all adult patients who underwent bariatric surgery, identified using ICD-10 procedure codes. The primary explanatory variable was nSES, operationalized using DCI quintiles, linked to patient ZIP codes. The primary outcomes were hospital length of stay (continuous variable) and readmission (binary variable: Yes/No). Multivariate linear regression (for hospital stay) and logistic regression (for readmission) were performed, adjusting for demographic factors (age, sex, race/ethnicity), clinical characteristics (preexisting comorbidities using the Charlson Comorbidity Index (CCI) and, obesity class), and socioeconomic indicators (insurance type) and Geographic classification. Interaction terms were included to evaluate whether race/ethnicity modified the association between nSES and these outcomes.

Result Among 10,784 bariatric surgery recipients, the majority were Black (48.3%), female (83.1%), with a mean age of 44.1 ± 11.6 years. Length of stay did not differ significantly by DCI Quintiles; patients in distressed areas had similar odds of prolonged hospitalization compared to those in prosperous areas (β = 0.045; 95% CI: –0.111 to 0.201; p = 0.575). Readmission risk was higher in distressed neighborhoods (OR = 1.64; 95% CI: 0.76–3.54; p = 0.207), though not statistically significant. No interaction was observed between nSES and race/ethnicity.

Conclusion Residents of disadvantaged neighborhoods showed a non-significant trend toward higher readmission without increased hospital stay. Findings underscore the need to enhance post-discharge care for socioeconomically vulnerable populations.

The authors have declared no competing interest.

Yes

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The research protocol was reviewed and approved by the University of Maryland Institutional Review Board (2284677-1).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The data underlying the results of this study are available from the corresponding author upon reasonable request.