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Efficacy of a Required Preoperative Weight Loss Program for Patients Undergoing Bariatric Surgery
Eliza a. Conaty*, Nicolas J. Bonamici, Matthew E. Gitelis, Woody Denham, John G. Linn, Stephen P. Haggerty, Liz Farwell, Michael B. Ujiki
NorthShore University HealthSystem, Evanston, IL
Background: The efficacy of mandatory medically supervised weight loss (MSWL) prior to bariatric surgery continues to be a topic under dispute amongst healthcare providers, with no consensus offered in current scientific literature. We aimed to assess the efficacy of a MSWL program by comparing outcomes of patients undergoing primary bariatric surgery with and without a compulsory preoperative weight loss regimen.
Methods: A retrospective analysis was performed on a database of 757 patients who underwent primary bariatric surgery between March 2008 and November 2014. Patients were divided into two cohorts based on their participation in a medically supervised preoperative weight loss program requiring at least 10% excess weight loss (EWL). Patients in both groups were placed on a liquid diet prior to surgery. Records were evaluated at 3,6,12, and 24 months after surgery for weight loss, comorbidity resolution, and the occurrences of hospital readmissions and reoperations.
Results: A total of 757 patients met inclusion criteria, of whom 286 participated in mandatory preoperative weight loss while 471 patients underwent surgery without a preoperative requirement. One year after surgery, 60% (79) of MSWL participants and 61% (191) of non-participants showed a resolution of at least one of six associated comorbidities. MSWL participants showed an average of 63.5% EWL, while non-participants showed 68.8% EWL. Neither comorbidity resolution nor %EWL was shown to be significant (p>0.05) between cohorts 12 months after surgery. Readmission and reoperation rates among MSWL participants (7.7%, 4.9%, respectively) were lower than among non-participants (13.8%, 13.6%). These differences in hospital readmissions and reoperations between cohorts were shown to be significant (p=0.012 and p=0.0001, respectively).
Conclusions: The requirement for patients to enroll in a preoperative weight loss program did not result in greater %EWL or comorbidity resolution 12 months after surgery. However, the program significantly decreased the rates of readmission and reoperation for these patients within one year. This suggests that the efficacy of such a program should be considered in the context of readmissions and reoperations after bariatric surgery.
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