Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

BACKGROUND: Adherence to follow-up visits is often unsatisfactory after bariatric surgery. OBJECTIVES: To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018). METHODS: Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years). RESULTS: Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m2. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (Ps < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (Ps < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively. CONCLUSION: Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.

Post-bariatric surgery reconstruction: patient myths, perceptions, cost, and attainability strategies.

BACKGROUND: A discrepancy exists between patient perceptions of post-bariatric surgery reconstruction and cost, value, and ultimate attainability. The authors investigated prospective gastric bypass patients to identify misconceptions and strategies to aid in the attainability of post-bariatric surgery reconstruction. METHODS: One hundred seventy-six prospective gastric bypass patients were surveyed for perceptions of plastic surgery, a "club" concept integrating plastic surgical/bariatric teams, and payment strategies. Cost comparisons were set up for comparison with major consumer purchases. Outcome measures were assessed by univariate analyses. RESULTS: One hundred seventy-four patients (139 women and 35 men; mean age, 42.3 years; mean body mass index, 49.3) completed the survey; 65.9 percent expressed an interest in plastic surgery (women were more interested than men) (p < 0.05); 73.1 percent wanted their plastic surgeon affiliated with the bariatric surgeon/team; 47 percent wanted to meet the plastic surgeon before their gastric bypass; and 14.4 percent equated the cost of a total body lift to the cost of a new car versus 31.9 percent for a trip to Disneyworld, 23.8 percent for a television, and 16.3 percent for a radio. Estimated costs for plastic surgery were undervalued by 60 percent. Sixty percent were interested in a club with a monthly fee that would go toward future plastic surgery. Other payment strategies were less popular. None of the independent variables predicted the degree of interest in any particular plan. CONCLUSIONS: Future gastric bypass patients, particularly women, are a unique population with common misconceptions regarding post-bariatric surgery reconstruction. Early patient education and financial awareness, in combination with preexisting or newly created bariatric centers, may improve attainability for this population.