Anahita D Jalilvand, MD, Alecia Blaszczak, BS, Andrew Detty, BA, Jane Dewire, Bradley J Needleman, MD, Sabrena F Noria, MD, PhD. The Ohio State Wexner Medical Center
INTRODUCTION: Follow up after bariatric surgery (BS) is known to be an important predictor of post-operative weight loss. The primary goal of this study was to determine predictors of poor follow-up and weight loss outcomes in a single, large-volume academic bariatric center.
METHODS: We retrospectively reviewed all patients undergoing primary laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) between 2014-2016, by two experienced bariatric surgeons. Baseline demographic, psychosocial, and medical data were obtained on all patients. Patients who did not present to the bariatric clinic at scheduled post-operative visits were categorized as “no-shows”. Poor weight loss was defined as the lowest quartile (<25th) of % excess body weight loss (%EBWL-25th) at each time point. Independent predictors of %EBWL-25th and follow-up at 6, 12, 24, an 36 months were determined using multiple logistic regressions (MLR), and a p value <0.05 was considered statistically significant.
RESULTS: Of the 570 patients reviewed, the no-show rates at 6,12, and 24 months after BS were 20.2% (n=115), 34.1% (n=194), and 55.8% (n=318). The no-show rate for eligible patients at 3 years was 69.3% (n=214). Undergoing LSG was an independent predictor of no-shows at 6, 12, and 24 months post BS. However, the only predictor of no-shows at 3 years was younger age (OR 1.02, p=0.04). Independent predictors of %EBWL-25th at 6-months included higher baseline BMI (OR 1.1, p<0.005), insulin-dependent diabetes (OR 3.7, p=0.005), LSG (OR 4.0, p<0.0005), and African American (AA) race (1.7, p=0.003). At 12-months, higher preoperative BMI (OR 1.1, p<0.005) and LSG (OR 6.2, p<0.005) remained significant, but patients with less than a highschool education also predicted %EBWL-25th. At 24 months, while LSG and high baseline BMI remained significant predictors of %EBWL-25th, so too did AA race (OR 3.07, p=0.03), baseline depression (OR 2.9, p=0.009), and no-shows at 6-months (OR 4.75, p=0.04). At 36-months, significant predictors of %EBWL-25th included LSG (OR 29.1, p=0.001) and higher binge eating scores (OR 7.3, p=0.02). Patients in the %EBWL-25th at 36 months had significantly higher no-show rates at 6-months (100% vs 43.9%, p=0.002) and 12-months (90.9% vs 43.6%, p=0.006).
CONCLUSIONS: Our results suggest that patients undergoing LSG are more likely to have poor follow-up and weight-loss in both the short and long-term after BS. Given the increasing demand for LSG, further studies are needed to determine whether the etiology is related to the surgical procedure itself, and/or characteristics of patients who choose to undergo LSG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95660
Program Number: S116
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium