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Compliance With Bariatric Surgery Follow-Up and Weight Loss Outcomes
Britney Corey*, Lauren Goss, Allison A. Gullick, David Breland, Joshua Richman, Jayleen Grams
Surgery, University of Alabama at Birmingham, Birmingham, AL
Introduction: Guidelines for follow-up after bariatric surgical procedures include a minimum of six times during the first two years following operation, with annual visits thereafter. Patient non-adherence to these recommendations is high. The purpose of this study was to evaluate the impact of follow-up compliance during the first two postoperative years after laparoscopic Roux-en-Y gastric bypass (LRYGB) on weight loss outcomes. We hypothesized that lower compliance would predict lower weight loss.
Methods: Retrospective review was conducted of all adult patients who underwent LRYGB from 2005-2013 at a single institution. Patients were stratified by follow-up attendance at a total of 8 possible postoperative visits: low=0-3 and high=4-8 visits. Univariate and multivariate analyses were used to compare patient characteristics and compliance. Mixed-effects multivariate linear regression was used to model % weight loss over time by compliance group. Statistical significance was determined by p <0.05.
Results: Of 756 patients, the majority were female (77.1%), of white race (75.2%), and median age was 42 years (IQR 36-50). There were 252 patients in the low and 504 patients in the high compliance groups. The low compliance group was younger (p<0.001) and tended to be male but this was not statistically significant (p=0.058). On adjusted analysis, % weight loss was not significantly different at 1 or 2 years of follow up between the groups based on compliance (p=0.8451 and p=0.0785, respectively). On generalized linear models accounting for all bariatric visits, however, there was a significant difference in weight loss with the low compliance group having a lower % weight loss (p<0.001). When all weights were collected from any visit at the institution, not only at bariatric follow up, there was no statistically significant difference in % weight loss at 1 year but there was a lower % weight loss in the low compliance group at 2 years (p=0.3551 vs p=0.0013, respectively). This persisted in generalized linear models (p<0.001).
Conclusion: Patients who were more compliant with their post-operative visits achieved greater weight loss following LRYGB. Reasons for low follow-up compliance need to be better understood in order to improve patient outcomes.
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