Quality of Follow-up

Switzer, Noah; Merani, Shaheed; Skubleny, Daniel; Pelletier, Jean-Sébastien; Kanji, Raisa; Shi, Xinzhe; Birch, Daniel W.; Gara, Christopher de; Sharma, Arya M.; Gill, Richdeep S.; Karmali, Shahzeer

doi:10.1097/sla.0000000000001478

Cited by 24 publications

(2 citation statements)

References 110 publications

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“…Studies of bariatric surgery are known to have poor follow-up rates with a recent large systematic review showing a mean of 40% attrition at one year and even higher rates at study completion [25], highlighting the challenges of this patient population. Our follow-up was notably better than this with 71.7% at 1 year, 54.3% of patients completing the study and data availability of over 60% at 2 years and over 50% at 5 years.…”

Section: Discussionmentioning

confidence: 99%

Milestone Weight Loss Goals (Weight Normalization and Remission of Obesity) after Gastric Bypass Surgery: Long-Term Results from the University of Michigan

et al. 2017

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Background Rates of weight normalization and obesity remission after Roux-en-Y gastric bypass (GB) are unknown. This study evaluated weight loss, rates of achieving body mass index (BMI) < 25 or 30 kg/m2, recidivism, and predictors of success following GB. Methods We retrospectively studied weight and BMI at baseline, 2 and 6 months, and annually at 1–7 years in 219 patients undergoing GB at the University of Michigan from January 2008 to November 2010. Results Follow-up was excellent for a population traditionally associated with high attrition rates with data availability of 157/219, 145/219, 144/219, 134/219, 123/219, 82/161, and 29/64 patients at 1–7 years respectively. Mean baseline BMI was 47.0 kg/m2. Weight normalization (BMI < 25 kg/m2) occurred in 2.3–6.8% of patients. More importantly, 47% of patients achieved remission of obesity (BMI < 30 kg/m2) at some time point and 24% (52/219) at the last observed time point. BMI < 30 kg/m2 was associated with a lower initial BMI and follow-up for more than 2 years. Conclusions Rates of weight normalization are low after GB, however a large number of patients achieved BMI < 30 kg/m2. While the percent total weight loss and excess weight loss are both quite high in the entire cohort and this is likely associated with significant health benefits, our results still underscore the need to address obesity with intensive clinical attention earlier in its course.

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Section: Discussionmentioning

confidence: 99%

Milestone Weight Loss Goals (Weight Normalization and Remission of Obesity) after Gastric Bypass Surgery: Long-Term Results from the University of Michigan

et al. 2017

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“…However, loss to follow-up rates at 1 year after bariatric surgery is as high as 56%. [11][12][13] How to enhance patient engagement in longitudinal follow-up after bariatric surgery remains unknown. Though a number of risk factors for loss to postsurgical follow-up have been identified, such as greater presurgical weight 14 and greater travel distance, 15 no studies have systematically evaluated strategies to mitigate loss to follow-up.…”

mentioning

confidence: 99%

Financial Incentives to Improve Patient Follow-up and Weight Loss After Bariatric Surgery

Chao

Kullgren

Ross³

et al. 2021

Annals of Surgery

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Objective: To examine effects of a financial incentives program on follow-up and weight loss after bariatric surgery. Summary Background Data: Consistent follow-up may improve weight loss and other health outcomes after bariatric surgery. Yet, rates of follow-up after surgery are often low. Methods: Patients from 3 practices within a statewide collaborative were invited to participate in a 6-month financial incentives program. Participants received incentives for attending postoperative appointments at 1, 3, and 6 months which doubled when participants weighed less than their prior visit. Participants were matched with contemporary patients from control practices by demographics, starting body mass index and weight, surgery date, and procedure. Preintervention estimates used matched historic patients from the same program and control practices with the criteria listed above. Patients between the 2 historic groups were additionally matched on surgery date to ensure balance on matched variables. We conducted difference-in-differences analyses to examine incentives program effects. Followup attendance and percent excess weight loss were measured postoperative months 1, 3, 6, and 12. Results: One hundred ten program participants from January 1, 2018 to July 31, 2019 were matched to 203 historic program practice patients (November 20 to December 27, 2017). The control group had 273 preinter-vention patients and 327 postintervention patients. In difference-indiffer-ences analyses, the intervention increased follow-up rates at 1 month (+14.8%, P < 0.0001), 3months (+29.4%, P < 0.0001), and 6 months (+16.4%, P < 0.0001), but not at 12 months. There were no statistically significant differences in excess weight loss. Conclusions: A financial incentives program significantly increased follow-up after bariatric surgery for up to 6 months, but did not increase weight loss. Our study supports use of incentivized approaches as one way to improve postoperative follow-up, but may not translate into greater weight loss without additional supports.

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Gastrointestinal symptoms and food intolerance 2 years after laparoscopic Roux-en-Y gastric bypass for morbid obesity

Boerlage

Laar

Westerlaken

et al. 2016

British Journal of Surgery

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BackgroundLaparoscopic Roux‐en‐ gastric bypass (LRYGB) is an effective treatment for morbid obesity, but might aggravate gastrointestinal complaints and food intolerance. The long‐term prevalence of these symptoms has not been well studied.MethodsIn a cross‐sectional study, all patients who underwent primary LRYGB from May to October 2012 were approached 2 years after surgery to complete a general health questionnaire, the Gastrointestinal Symptom Rating Scale (GSRS), and a food intolerance questionnaire. The results were compared with those for a control group of morbidly obese patients.ResultsA total of 249 patients were included for analysis, representing a response rate of 93·9 per cent. Mean(s.d.) total weight loss was 30·8(8·7) per cent. The total mean GSRS score was higher in patients who had LRYGB (median 2·19 versus 1·75 in unoperated patients; P < 0·001); the difference in symptoms of indigestion was most notable (P < 0·001). Food intolerance for specific products was reported by 70·7 (95 per cent c.i. 64·8 to 76·0) per cent of the postoperative patients, for a median of 4 foods. There was a positive correlation between food intolerance and score on the GSRS. There was no correlation between either food intolerance or the total mean GSRS score and weight loss, but there was a correlation between weight loss and abdominal pain.ConclusionAt 2 years after surgery, patients undergoing LRYGB for morbid obesity have more gastrointestinal complaints than obese controls. Food intolerance is a common side‐effect of LRYGB independent of degree of weight loss or the presence of other abdominal symptoms.

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Quality of Follow-up

Cited by 24 publications

References 110 publications

Milestone Weight Loss Goals (Weight Normalization and Remission of Obesity) after Gastric Bypass Surgery: Long-Term Results from the University of Michigan

Milestone Weight Loss Goals (Weight Normalization and Remission of Obesity) after Gastric Bypass Surgery: Long-Term Results from the University of Michigan

Financial Incentives to Improve Patient Follow-up and Weight Loss After Bariatric Surgery

Gastrointestinal symptoms and food intolerance 2 years after laparoscopic Roux-en-Y gastric bypass for morbid obesity

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