BMI Course Over 10 Years After Bariatric Surgery and Biopsychosocial Complexity Assessed with the INTERMED: a Retrospective Study

Abstract

Background While bariatric surgery is an effective therapy for patients with severe obesity, not all patients benefit equally. An explanation might be that psychosocial risk factors hamper outcome. The study aimed to evaluate if biopsychosocial case complexity predicts evolution of BMI over 10 years after bariatric surgery. Methods Charts of patients (N = 236) of the Cohort of Obesity Lausanne (COOL) were retrospectively reviewed and rated with the INTERMED, a reliable and validated instrument, which assesses biopsychosocial case complexity and has been proven to predict outcome of medical treatments in different patient populations. The sample was stratified into BMI quartiles, computed from the patients’ baseline BMI. For each quartile, BMI evolution was analyzed using individual growth curve analysis. Results Growth curve analyses showed that in quartiles 1, 2, and 3, none of the INTERMED domain scores significantly predicted the BMI evolution after surgery. However, in the fourth quartile—including patients with the highest pre-surgical BMI—the social domain score of the INTERMED significantly predicted BMI evolution: patients with more social complexity showed higher increase in BMI. Conclusion Effectiveness of interventions targeted at social complexity, especially when patients suffer from severe obesity, may therefore be evaluated in future studies. Graphical abstract

Complexity in palliative care inpatients: prevalence and relationship with provision of care, a retrospective study

“…While patient populations may differ between palliative care inpatient units, the mortality rate of our study population is similar to those of other palliative care inpatient units (43). Regarding the prevalence of case complexity, almost all patients showed an INTERMED score above 21, which is a three times higher prevalence than the prevalence found in patients with chronic disease (38,41). This population's extraordinarily high biopsychosocial complexity, which remains stable over the course of the hospital stay, justi es interdisciplinary care and associated human resources.…”

“…Retrospective chart-based rating has been proved to be reliable: in a previous study: interrater reliability of retrospective ratings reached an intra class correlation (ICC) of 0.91 (41).…”

“…The INTERMED can be scored by means of a semi-structured interview, a self-assessment or retrospectively based on patient charts (41).…”