Predictors of Postoperative Aftercare Attrition among Gastric Bypass Patients

Abstract

Background: Poor adherence to post-bariatric surgery aftercare continues to challenge surgical practices. The objective of this study was to identify factors that predict poor aftercare attendance among patients who underwent Roux-en-Y Gastric Bypass (RYGB) surgery. Method: A retrospective medical chart review of patients who underwent RYGB from 2002 to 2011 was conducted. Patients with four visits or more in the first 2 years ( > 50%) were categorized as ''acceptable follow-up'' and with £ 50% as ''poor follow-up.'' Demographics, presurgical body mass index (BMI), and comorbidities were compared using multivariate analysis. Results: Out of 2,658 patients, 1,092 (41.1%) had acceptable follow-up. Preoperative factors that predicted acceptable follow-up included female gender (odds ratio [OR] 1.41 [95% confidence interval (CI) 1.15-1.72]), older age (OR 1.03 [95% CI 1.03-1.04]), higher BMI at surgery (OR 1.02 [95% CI 1.01-1.03]), and Hispanic ethnicity (OR 1.40 [95% CI 1.15-1.72]). Conversely, presence of diabetes mellitus (OR 0.58 [95% CI 0.39-0.88]), hypertension (OR 0.53 [95% CI 0.39-0.72]), and obstructive sleep apnea (OR 0.39 [95% CI 0.26-0.57]) predicted less adherence to RYGB aftercare. Conclusion: These findings suggest RYGB patients' age, gender, ethnicity, preoperative BMI, and certain comorbidities should be considered to maximize postoperative aftercare attendance.

Predictors of poor follow-up after bariatric surgery

“…As for the Ethanol, which also entered the model, showed no association (p>0.05) (Table 4). International surveys indicate progressively low rates of adherence to scheduled appointments in the postoperative period: 50% in the first year, 30% in two years, and <10% in ten years 9,18,19 . In Brazil, despite extensive research, we found no specific studies on the rates of medical-surgical followup, only nutritional.…”

“…In this context, laparoscopic Sleeve gastrectomy (LSG) presents lower morbidity, but with complications that may require long-term reoperations. Therefore, regular medical-surgical and multiprofessional follow-up is extremely important to prevent and treat complication soon 9,10 . The Brazilian recommendations for postoperative follow-up emphasize the regularity and importance of maintaining it, to early detect metabolic and nutritional changes, as well as to monitor weight [11][12][13][14][15] .…”

“…One is to keep the patients in the protocol of consultations adopted with the surgeon or multiprofessional team 11 . Studies report high followup loss rates, above 49%, in the first postoperative year 9,12,16 , but there is no consensus regarding the reasons for patients not adhering to the recommended follow-up 1 -Federal University of Pernambuco, Department of Surgery, Recife, PE, Brazil.…”

Moral Biocitizenship: Discursively Managing Food and the Body after Bariatric Surgery

“…Some research indicates that male patients have a particularly difficult time conforming to medicalized ideas about “adherence” following bariatric surgery (Khorgami et al. ; Toussi et al. ).…”

“…One of the most detailed ethnographic studies of post-surgical patients (in Norway) concluded that men still struggled to negotiate their new bodies and the effects of surgery five years afterward (Natvik et al 2015). Some research indicates that male patients have a particularly difficult time conforming to medicalized ideas about "adherence" following bariatric surgery (Khorgami et al 2015;Toussi et al 2009). Other scholarship has investigated the ways in which men's intimate and professional relationships are altered following bariatric surgery (Moore, Brooks, and King 2016;Moore and Cooper 2016).…”