Am I on Track? Evaluating Patient-Specific Weight Loss After Bariatric Surgery Using an Outcomes Calculator.

PURPOSE: Individual weight loss outcomes after bariatric surgery can vary considerably. As a result, identifying and assisting patients who are not on track to reach their weight loss goals can be challenging. MATERIALS AND METHODS: Using a bariatric surgery outcomes calculator, which was formulated using a state-wide bariatric-specific data registry, predicted weight loss at 1 year after surgery was calculated on 658 patients who underwent bariatric surgery at 35 different bariatric surgery programs between 2015 and 2017. Patient characteristics, postoperative complications, and weight loss trajectories were compared between patients who met or exceeded their predicted weight loss calculation to those who did not based on observed to expected weight loss ratio (O:E) at 1 year after surgery. RESULTS: Patients who did not meet their predicted weight loss at 1 year (n = 237, 36%) had a mean O:E of 0.71, while patients who met or exceeded their prediction (n = 421, 63%) had a mean O:E = 1.14. At 6 months, there was a significant difference in the percent of the total amount of predicted weight loss between the groups (88% of total predicted weight loss for those that met their 1-year prediction vs 66% for those who did not, p < 0.0001). Age, gender, procedure type, and risk-adjusted complication rates were similar between groups. CONCLUSION: Using a bariatric outcomes calculator can help set appropriate weight-loss expectations after surgery and also identify patients who may benefit from additional therapy prior to reaching their weight loss nadir.

Factors associated with bariatric surgery utilization among eligible candidates: who drops out?

BACKGROUND: Bariatric surgery is underutilized. OBJECTIVES: To identify factors associated with eligible patient dropout from bariatric surgery. SETTING: University hospital, United States. METHODS: Eligible candidates were identified after a multidisciplinary review committee (MRC) of all patients (n = 484) who attended a bariatric surgery informational session (BIS) at a single-center academic institution in 2015. We compared patients who underwent surgery within 2 years of BIS with those who did not (i.e., dropped out) by evaluating patient, insurance, and program-specific variables. Univariate analyses and multivariable regressions were performed to identify factors associated with patient dropout among eligible candidates. RESULTS: We identified 307 (63%) patients who underwent MRC. Thirty-three (11%) patients were deemed poor candidates and surgery was not recommended. Among eligible candidates, 82 (30%) dropped out from the program. Factors independently associated with eligible patient dropout included coronary artery disease (odds ratio [OR] .13 [.02-.66]; P = .014), hypertension (OR .46 [.24-.87]; P = .017), time from BIS to MRC (OR .99 [.99-.99]; P = .002), 3 months of medically supervised weight loss documentation (OR .09 [.02-.51]; P = .007), endocrinology clearance (OR .26 [.09-.76]; P = .014), hematology clearance (OR .37 [.14-.95]; P = .039), urine drug screen testing (OR .31 [.13-.72]; P = .006), additional psychological evaluation (OR .43 [.20-.93]; P = .031), and required extra sessions with the dietician (OR .39 [.17-.92]; P = .032). Thirty-three (6.8%) patients underwent surgery at another institution, and 42% of these patients lived more than 50 miles from attended BIS site. CONCLUSIONS: Twenty-seven percent of patients did not undergo bariatric surgery at their initial site of evaluation despite being considered eligible candidates after MRC. Dropout was independently associated with patient, insurance, and program-specific variables that may represent barriers to care amenable to improvement.