The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery

Abstract

Introduction Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear. Materials and Methods Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden. Results A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first-or secondgeneration immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001). Conclusion At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.

The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

“…After adjustment for other potential risk factors, the risk for less weight loss among patients born outside of the Nordic countries, and in particular outside of Europe, was equivalent to the effect of strong patient-demographic factors such as age, sex, and metabolic comorbidities. This group of patients may also experience higher complication rates [ 16 ] as well as less improvement in HRQoL [ 17 ]. Although there may be a difference in the response to bariatric surgery between ethnic groups [ 11 , 24 ], the inferior weight loss among first-generation immigrants could be related to difficulties in their ability to understand and apply preoperative information (health literacy), failure to appreciate the importance of patient involvement, lack of a supportive network, and simple misunderstandings due to language or cultural mismatch between care providers and patients [ 25 ].…”

“…Patients residing in larger cities had lost less weight 5 years after surgery than patients residing in small towns or municipalities. This group of patients has also been reported to be lost to follow-up more often and report less improvement in health-related quality of life after bariatric surgery [ 17 , 28 ]. The explanation for this is likely to be multifactorial, including behavioural and sociopsychological factors not considered in the present study.…”

“…Although this result contradicts the result of a recent Swiss study including 444 patients [ 6 ], it is supported by older studies [ 11 ]. Women also attend follow-up visits more often than men [ 28 ] and experience better improvement in health-related quality of life [ 17 ]. The better compliance and results among women may well be the result of different motivations for surgery.…”

“…A low socioeconomic status has been reported to be associated with higher complication rates and poorer outcomes after surgical procedures [ 13 – 15 ]. Recent studies have shown the same applies to gastric bypass surgery, with an increased risk for postoperative complications and less improvement in quality of life [ 16 , 17 ]. The recognition of risk factors for inadequate postoperative weight loss that can be identified preoperatively may help in identifying certain groups of patients who require increased support in the pre- and postoperative setting.…”

Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients’ experiences during 2 years of follow-up

“…Age, lower preoperative BMI, male gender, higher education, professional status, and disposable income were associated with a higher postoperative HRQoL. [23].…”