Original article
Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery

https://doi.org/10.1016/j.soard.2015.11.007Get rights and content

Abstract

Background

Long-term multidisciplinary care after bariatric surgery is important for weight maintenance and management of co-morbidities. Despite this, the rate of attendance to follow-up appointments is universally low.

Objective

To identify patient factors that contribute to adherence to follow-up care after bariatric surgery.

Setting

Three university-affiliated hospitals in Canada

Methods

A cohort study of 388 patients who underwent bariatric surgery from January 2011 to December 2011 was performed. This program mandates multidisciplinary follow-up care at 3, 6, and 12 months, and annually thereafter. Patients’ socioeconomic, psychosocial, and medical and psychiatric co-morbidities were recorded prospectively. Adherence to follow-up care was defined as having attended the majority of clinic visits (3 or 4 out of 4); all other patients were considered nonadherent.

Results

The mean age of patients was 45.0 years, 81.2% were female, and the majority underwent a gastric bypass (91.8%) versus a sleeve gastrectomy (8.2%); 62.1% of patients were adherent to follow-up appointments. Patients older than 25 years had a higher adherence rate than those who were younger (63.2% versus 37.5%, P = .040). Patients with full-time or part-time employment had a significantly higher adherence rate than those who were unemployed or retired (65.6% versus 50.0%, P = .017, odds ratio 1.9). Patients with obstructive sleep apnea (OSA) before surgery had higher follow-up adherence than those without OSA (62.2% versus 37.8%, P = .044). In multivariate analysis, employment remained an independent predictor of follow-up adherence (P = .017).

Conclusion

Employment was the strongest predictor of attendance to follow-up clinic. Patients with OSA and older patients were also more likely to return consistently for scheduled follow-up.

Section snippets

Study population

This was a cohort study of prospectively collected data on patients who underwent bariatric surgery (laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy) from January 1, 2011 to December 1, 2011 through the University of Toronto Bariatric Surgery Collaborative. This program consists of an interprofessional team of surgeons, psychiatrists, psychologists, nurse practitioners, dieticians, and social workers, who assess patients for bariatric surgery and provide bariatric aftercare for up

Results

Of 393 consecutive patients who underwent bariatric surgery in the program between January 1, 2011 to December 1, 2011, a total of 388 patients consented to participate in prospective data collection; 315 (81.2%) were female and 73 (18.8%) were male. Average age at time of surgery was 45.0 (±11.12) years. All surgeries were performed at 1 of 3 teaching hospitals by a total of 8 surgeons, all of whom had similar expertise and operated on a similar proportion of these patients (46±9). Three

Discussion

In this study, the authors sought to identify predictors of follow-up adherence after bariatric surgery in a publicly funded healthcare system. Unlike many other studies, patient data on a comprehensive list of potential influencing variables was collected prospectively to inform this analysis. Indicators of psychosocial health and medical co-morbidities along with demographic characteristics, economic status, and anthropometrics were included in this multivariable analysis. The authors

Conclusion

Despite a universal healthcare system, attrition remains a problem to follow-up care post–bariatric surgery. Although no direct healthcare costs are incurred by patients in this system, employment status affects patient compliance to follow-up care post–bariatric surgery. The indirect costs of follow-up care for patients must be considered and minimized. The cost of returning must also be balanced against the benefit for patients.

As more people undergo bariatric surgery, the need for

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (25)

  • N.V. Christou et al.

    Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years

    Ann Surg

    (2006)
  • T.D. Adams et al.

    Health benefits of gastric bypass surgery after 6 years

    JAMA

    (2012)
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