Longitudinal Assessment of Bariatric Surgery (LABS): Retention strategy and results at 24 months

Abstract

Background Retaining participants in observational longitudinal studies following bariatric surgery is difficult yet critical because the retention rate affects interpretation and generalizability of results. Strategies for keeping participants involved in such studies are not commonly published. Objective To review LABS retention strategies and present the 24-month retention data Methods The LABS Consortium monitors an observational cohort study of 2458 adults enrolled prior to bariatric surgery at 10 centers within the United States (LABS-2). To maximize data completeness, the investigators developed retention strategies including flexible scheduling, a call protocol, reminder letters, abbreviated visit options, honoraria, travel reimbursement, providing research progress reports, laboratory results, newsletters, study website, and retention surveys. Strategies for locating participants included frequent updates of contact information, sending registered letters, and searching medical and public records. Results At 12 and 24 months, 2426 and 2405 participants remained active, with vital status known for 98.7% and 97.3% and weight obtained for 95.2% and 92.2% respectively. There were 148 missed visits (6.2%) at 24 months primarily because of inability to contact the participant. Only 15 (0.6%) active participants at 24-months missed all follow-up visits. Though 42 participants could not be located or contacted at 6 months, data were obtained for 23 (54.7%) of them at 12 months, and of the 52 participants who could not be located or contacted at 12 months; data were obtained for 18 (34.6%) at 24 months. Conclusion Longitudinal studies provide the ability to evaluate long-term effects of bariatric surgical procedures. The retention achieved in LABS is superior to many published reports but requires extensive effort and resources. This report identifies useful retention strategies. Further research is needed to identify the efficacy and cost effectiveness of specific retention strategies.

Obese patients lose weight independently of nutritional follow-up after bariatric surgery

“…2,13,14 Nevertheless, most major RYGBP series have shown a 60-50% postoperative follow-up rate at 1 year, which drops off dramatically with time. 15 These estimates are similar to the overall adherence prevalence of 51% (95%CI: 44.5-57.5%) during the 18-month follow-up period of our study.…”

“…Several authors argued that patients who stop attending postsurgical visits shortly after surgery might differ from patients who are lost to follow-up later in the multidisciplinary care program. 4,15 Evaluating early and late attrition separately when analyzing adherence factors may be particularly pertinent to further explore this issue.…”

“…As reported by Harper et al, 6 one of the main reasons for low follow-up attendance is that the patient is doing well during the first 12-18 months ("honey-moon phase") and may feel that continual follow-up is not necessary. Similarly, Gourash et al 15 highlight the importance of putting into place diverse strategies to minimize attrition. In a recent review, Rudolph and Hilbert 14 argued that continued postoperative behavioral management is especially important after 12-18 months, when weight loss decelerates or weight regain occurs.…”

Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data

“…This difficulty in long-term patient follow-up has plagued bariatric surgical outcomes research, particularly retrospective analyses. A study from the Longitudinal Assessment of Bariatric Surgery (LABS) identified key strategies to address this problem of patient retention, including honoraria, travel reimbursement, providing patient progress reports, continual updating of patient contact information, and standardized scheduling and patient contact protocols [35]. Future efforts should focus on these strategies to improve patient participation and optimize reporting of results.…”

Predictors of Postoperative Aftercare Attrition among Gastric Bypass Patients

“…11,12 Moreover, poor retention in postoperative bariatric aftercare has detrimental effects on patient safety due to delayed diagnosis of complications and also on unbiased and internal and external research study results. 13 Most bariatric surgery centers have standardized patient postoperative aftercare protocols, but regardless, patient attrition is a consistent problem in the field, particularly beyond 1 year after surgery. 14 The literature reports that follow-up rates can be as low as 50% at 1 year, 12,15 30% at 2 years, and < 10% at 10 years after surgery.…”