A VA-Based Multidisciplinary Clinic Improves Follow-Up After Bariatric Surgery

Nalani Grace, MD, Eric Kubat, MD, Dan Eisenberg, MD, MS. VA Palo Alto

Introduction: Outpatient follow-up after bariatric surgery is associated with improved outcomes and patient satisfaction.  At our Veterans Affairs Medical Center (VAMC) we have established a unique multidisciplinary clinic.  We sought to examine whether 1-year postoperative follow-up would increase as a result.

Methods: A retrospective review of a prospective database of patients who underwent gastric bypass or sleeve gastrectomy between 2003 and August 2014. A multidisciplinary clinic which includes a patient assessment by a surgeon, bariatrician, dietitian, physical therapist, and psychologist at each visit, was established at our VAMC in 2008.  Significant differences were determined using a t-test.

Results: Of 221 patients who underwent bariatric surgery at our VAMC, 97 (44%) were followed before institution of a multidisciplinary clinic (PRE), and 124 (56%) were followed after institution of a multidisciplinary clinic (POST). Most were male (78%), and mean pre-operative BMI was similar in both groups (47 kg/m2 and 46 kg/m2, respectively).  The rate of follow-up at 1 year after surgery was significantly higher in the POST group, compared to the PRE group (85% and 76%, respectively; p=0.037).  Despite the fact that most patients in the PRE group underwent gastric bypass (96%), while most patients in the POST group underwent sleeve gastrectomy (88%), the remission of diabetes (66% vs. 69%, p=0.86) and remission of hypertension (42% vs. 47%, p=0.55) were similar in both groups. The decrease in BMI experienced in the first post-operative year was higher in the PRE compared with the POST group (DBMI=14 vs. 11 kg/m2, respectively, p<0.01).

Conclusion: A dedicated multidisciplinary weight loss clinic leads to better short-term follow-up after bariatric surgery.  As the proportion of sleeve gastrectomy operations increases in the veteran population, a VA-based multidisciplinary clinic may prove effective in maintaining postoperative outcomes similar to gastric bypass.  

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