Rafael Alvarez, MD, Niki Matusko, MSc, Colleen M Buda, PAC, Oliver A Varban, MD. University of Michigan
Background: Despite its known safety and efficacy, bariatric surgery is an underutilized treatment for morbid obesity in the United States.
Objective: Our goal was to identify factors associated with failing to proceed with surgery despite being considered an eligible candidate by a bariatric surgery program.
Methods: This is a retrospective study that includes all patients (n=486) who attended a bariatric surgery informational session (BIS) at a single center academic institution in 2015. Eligible candidates were identified after clinical evaluation and multidisciplinary candidacy review (MCR). We compared patients who underwent surgery to those who did not (i.e. dropped out) by evaluating patient-specific, insurance-specific, and bariatric surgery program-specific variables. Univariate analysis and multivariable regression were performed to identify risk factors associated with failing to undergo surgery among eligible candidates.
Results: We identified 307 (63%) patients who completed all initial clinical evaluations and underwent MCR. Among these patients, 33 (11%) were deemed poor candidates and surgery was not recommended. Among the remaining eligible candidates, 82 (30%) did not undergo surgery. When compared to patients who underwent surgery (n=192), eligible patients who dropped out had higher rates of coronary artery disease (CAD) (11.0% vs 1.04%; p<0.0001), hypertension (HTN) (63.4% vs 42.7%; p=0.002), active smoking (18.3% vs 7.29%; p=0.007), and a longer waiting period between their BIS and MCR (164 days vs 103 days; p=0.004). In addition, patients who dropped out were more likely to have Medicare (18.75% vs 8.90%; p=0.022) and require 3 months (7.3% vs 1.0%; p=0.01) or 12 months (7.3% vs 2.1%; p=0.07) of medically supervised weight loss documentation (MSWLD). There was also a higher rate of program-specific requirements among patients who dropped out (7.2 vs 5.3 requirements, p<0.0001). Independent risk factors associated with decreased odds of undergoing surgery included: CAD (OR 0.13 [0.02-0.66]; p=0.014), HTN (OR 0.46 [0.24-0.87]; p=0.017), time from BIS to MCR (OR 0.99 [0.99-0.99]; p=0.002), 3 months of MSWLD (OR 0.09 [0.02-0.51]; p=0.007), endocrinology clearance (OR 0.26 [0.09-0.76]; p=0.014), hematology clearance (OR 0.37 [0.14-0.95]; p=0.039), urine drug screen testing (OR 0.31 [0.13-0.72]; p=0.006), required psychotherapy (OR 0.43 [0.20-0.93]; p=0.031), and required extra sessions with the dietitian (OR 0.39 [0.17-0.92]; p=0.032).
Conclusions: Approximately one third of patients did not undergo bariatric surgery despite being considered eligible candidates after multidisciplinary review. Dropout rates were independently associated with patient, insurance, and program-specific variables which may represent barriers to care amenable to improvement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86680
Program Number: P577
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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