Original article
Adherence to outpatient program postoperative appointments after bariatric surgery

https://doi.org/10.1016/j.soard.2008.01.013Get rights and content

Abstract

Background

Surgery is the only treatment that has been proved to have beneficial long-term effects for the morbidly obese (body mass index >40 kg/m2). One of the requirements for the Centers for Excellence program instituted by American Society for Bariatric Surgery is to have a system in place to provide comprehensive follow-up care. A recent study showed that the complication rate after bariatric surgery is 39.6% during the 180 days after discharge. Inadequate adherence to follow-up care has been recognized as contributory to the development of complications after bariatric surgery. The purpose of this study was to examine the variables that relate to patients' adherence to scheduled appointments after bariatric surgery.

Methods

A block entry logistic regression analysis was done from a database of an outpatient bariatric program that contained cross-sectional data collected for 1 year. Patient adherence to follow-up was defined as having 1 postoperative follow-up appointment within 90 days of undergoing surgery. A total of 375 subjects completed the preoperative program and underwent either laparoscopic Roux-en-Y gastric bypass (84.3%) or gastric banding (15.7%).

Results

Of the 14 variables used in the analysis, 5 were statistically significant (P <.05) predictors of adherence: age, body mass index, marital status, employment status, and insurance coverage.

Conclusion

Incorporation of the identified predictors into preoperative screening tools to flag patients at risk of nonadherence might improve follow-up care. Additional research is needed on possible interventions to decrease complications after bariatric surgery.

Section snippets

Methods

A retrospective data analysis was done using patient data collected from January 5, 2004 to January 27, 2005 by the Christiana Care Health System (CCHS) bariatric surgery program. The University of Delaware and CCHS institutional review boards approved the performance of the retrospective data analysis.

The patients selected had completed all the requirements of the preoperative bariatric surgery program and had undergone weight loss surgery. The 375 selected patients had undergone either

Results

The test of the full model with groups 1, 2, 3, and 4 added against a constant-only model was statistically reliable [calculated by chi-square (14, n = 375) = 67.55, P <.001], indicating that the variables, as a set, reliably distinguished between adherence and nonadherence. The model with 4 groups correctly classified 67.8% of the cases of adherence and nonadherence when all 14 predictors were in the model. Table 2 lists the estimates, standard errors, Wald test statistics, odds ratios [exp

Discussion

Of the 14 independent variables used, 5 were statistically significant predictors of a patient's adherence to follow-up care. In group 1, the psychological variables that assessed depression (Beck Depression Inventory) and eating habits (Eating Attitudes Test) were not significant. Our findings related to depression are in contrast to the findings of a meta-analysis of 569 adherence studies that reported depression to be significantly related to adherence [17]. In the present study, depression

Conclusion

Adherence with postoperative appointments has been shown to be associated with improved patient outcomes. We identified 5 significant predictor variables that affect patient adherence to postoperative appointments after bariatric surgery. The predictors that indicated more likely adherence were increasing patient age, being single, and being employed. The predictors that indicated less likely adherence were self-payment for appointments and a greater BMI. Incorporation of the identified

Disclosures

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

Acknowledgments

This work was partially supported by NIH grant P20 RR16472-04 from the INBRE program of the National Center for Research Resources.

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