Piotr J Gorecki, MD, Lindsay Bartholome, BA, Srikanth Eathiraju, MD, Leslie Wise, MD. New York Methodist Hospital, Brooklyn, NY
Objective: Purpose of the study was to examine why eligible patients scheduled for bariatric surgery ultimately cancel the procedure. Reasons for cancellation include patient, insurance, and program related issues. As bariatric surgery is the most effective treatment for morbid obesity, the benefits and safety of bariatric surgery resulted in recognition of it by insurance payers, both private and public, as medical necessity. However, a significant number of eligible patients seeking bariatric surgery will not receive the procedure.
Methods: A prospective database of 673 patients seeking bariatric surgery between 2005 and 2010 was reviewed. Patients who cancelled bariatric procedures after they were initially determined as eligible were identified. These patients were contacted by phone and completed a brief structured questionnaire that assessed reason for cancellation and remaining level of interest in bariatric surgery. Time interval from initial consultation to cancellation was examined.
Results: Total of 545 patients (81%) underwent primary bariatric surgery and 128 (19%) were identified as eligible for surgery but ultimately cancelled. Seventy-six cancelled patients (59%) completed the questionnaire. Demographic distribution of cancelled patients revealed 47% African American, 30% Hispanic, 20% white and 3% of other racial backgrounds. There were no significant differences in age, weight, and BMI between patients who underwent bariatric surgery and patients who cancelled. A significantly greater proportion of males cancelled surgery (24%) than underwent surgery (13%; chi square test, p=0.0008). White patients were significantly more likely to undergo surgery (37%) than cancel (20%; chi square test, p=0.0004). Among cancelled patients, there were 31 males (24%) with a mean age of 41.0 years and 97 females (76%) with a mean age of 41.3 years. Analysis of insurance status found 78% had private and 22% had public insurance. Reasons for bariatric surgery cancellation are displayed in Table 1. The mean weight (pounds) and BMI (kg/m²) at initial consultation and last follow up visit were 290/47.4 and 280/46.1 respectively. Mean time from initial visit to cancelation was 11.3 months (range 0.0-65.7 months), with no significant difference between females and males. During this time period, there was a mean decrease in weight of 10.9 pounds and BMI of 1.9 kg/m². Among cancelled patients, 61 (80%) continued to express interest in bariatric surgery.
Table 1: Reasons for cancellation – Comparison of patients who reported weight loss vs. weight gain from initial consultation to last follow up visit (Note 10 patients had unknown weight on questionnaire)
|
Reason for cancellation |
Overall % (n=76) |
Weight loss group % (n=45) |
Weight gain group % (n=21) |
| Patient related | 50% (38) | 49% (22) | 43% (9) |
| Insurance related | 32% (24) | 33% (15) | 33% (7) |
| Dr/Program related | 18% (14) | 18% (8) | 24% (5) |
Conclusions: A significant proportion of patients eligible for bariatric surgery will not receive the planned surgical intervention. The most common reasons for cancellation were patient related issues followed by insurance related issues. Efforts at early identification of such patients should be implemented to facilitate preoperative preparation and improve patient access to surgery.
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