Colleen Tewksbury1, Jingwei Wu2, Kelly C Allison3, Heather Gardiner2, Kristoffel R Dumon4, Noel N Williams4, David B Sarwer2. 1. Temple University College of Public Health, Philadelphia, Pennsylvania; Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Colleen.Tewksbury@uphs.upenn.edu. 2. Temple University College of Public Health, Philadelphia, Pennsylvania. 3. Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania. 4. Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: The prebariatric surgery assessment process can be challenging to patients and serve as a barrier to surgery. There is limited evidence to support its utility in improving postoperative outcomes for the majority of patients. OBJECTIVES: To assess the relationship between preoperative care and postoperative weight loss and follow-up in the first 2 postoperative years. SETTING: University Hospital, United States. METHODS: Frequency and duration of preoperative assessment and medical weight management contacts were retrospectively collected and assessed in relation to percent weight change over the first 24 months postoperatively in adults who underwent an initial bariatric surgical procedure between 2009 and 2014. RESULTS: Patients (n = 1303) were 44.4 ± 11.9 years with a body mass index of 48 ± 8.6 kg/m2. The frequency of preoperative contacts (all types) and duration of preoperative care were not associated with postoperative weight loss or follow-up. A greater number of individual (one-to-one) visits with the bariatric surgery team and additional psychology visits were associated with smaller postoperative weight losses (individual = -.27%, 95% confidence interval -.47%, -.07%; P = .01; psychology = -1.46%, 95% confidence interval -2.79%, -.12%; P = .03). CONCLUSIONS: These observations suggest the intensity and length of the preoperative assessment period is unrelated to early postoperative weight loss. Additional individual visits with the bariatric team and the psychologist before surgery were associated with smaller postoperative weight loss, suggesting that clinicians may be appropriately identifying complex patients and are making efforts to address this complexity with additional preoperative assessment and care.
BACKGROUND: The prebariatric surgery assessment process can be challenging to patients and serve as a barrier to surgery. There is limited evidence to support its utility in improving postoperative outcomes for the majority of patients. OBJECTIVES: To assess the relationship between preoperative care and postoperative weight loss and follow-up in the first 2 postoperative years. SETTING: University Hospital, United States. METHODS: Frequency and duration of preoperative assessment and medical weight management contacts were retrospectively collected and assessed in relation to percent weight change over the first 24 months postoperatively in adults who underwent an initial bariatric surgical procedure between 2009 and 2014. RESULTS:Patients (n = 1303) were 44.4 ± 11.9 years with a body mass index of 48 ± 8.6 kg/m2. The frequency of preoperative contacts (all types) and duration of preoperative care were not associated with postoperative weight loss or follow-up. A greater number of individual (one-to-one) visits with the bariatric surgery team and additional psychology visits were associated with smaller postoperative weight losses (individual = -.27%, 95% confidence interval -.47%, -.07%; P = .01; psychology = -1.46%, 95% confidence interval -2.79%, -.12%; P = .03). CONCLUSIONS: These observations suggest the intensity and length of the preoperative assessment period is unrelated to early postoperative weight loss. Additional individual visits with the bariatric team and the psychologist before surgery were associated with smaller postoperative weight loss, suggesting that clinicians may be appropriately identifying complex patients and are making efforts to address this complexity with additional preoperative assessment and care.