Barriers to bariatric surgery: Factors influencing progression to bariatric surgery in a U.S. metropolitan area.

Autor:	Ju T; Department of Surgery, The George Washington University, Washington, D.C.. Electronic address: tammyju@gwu.edu., Rivas L; Department of Surgery, The George Washington University, Washington, D.C., Arnott S; Department of Surgery, The George Washington University, Washington, D.C., Olafson S; School of Medicine and Health Sciences, The George Washington University, Washington, D.C., Whitlock A; School of Medicine and Health Sciences, The George Washington University, Washington, D.C., Sparks A; Department of Surgery, The George Washington University, Washington, D.C., Haskins IN; Department of Surgery, The George Washington University, Washington, D.C., Lin PP; Department of Surgery, The George Washington University, Washington, D.C., Vaziri K; Department of Surgery, The George Washington University, Washington, D.C.
Jazyk:	angličtina
Zdroj:	Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2019 Feb; Vol. 15 (2), pp. 261-268. Date of Electronic Publication: 2018 Dec 06.
DOI:	10.1016/j.soard.2018.12.004
Abstrakt:	Background: Bariatric surgery is an effective and durable treatment for obesity. However, the number of patients that progress to bariatric surgery after initial evaluation remains low. Objectives: The purpose of this study was to identify factors influencing a qualified patient's successful progression to surgery in a U.S. metropolitan area. Setting: Academic, university hospital. Methods: A single-institution retrospective chart review was performed from 2003 to 2016. Patient demographics and follow-up data were compared between those who did and did not progress to surgery. A follow-up telephone survey was performed for patients who failed to progress. Univariate analyses were performed and statistically significant variables of interest were analyzed using a multivariable logistic regression model. Results: A total of 1102 patients were identified as eligible bariatric surgery candidates. Four hundred ninety-eight (45%) patients progressed to surgery and 604 (55%) did not. Multivariable analysis showed that patients who did not progress were more likely male (odds ratio [OR] 2.2 confidence interval [CI]: 1.2-4.2, P < .05), smokers (OR 2.4 CI: 1.1-5.4, P < .05), attended more nutrition appointments (OR 2.1 CI: 1.5-2.8, P < .0001), attended less total preoperative appointments (OR .41 CI: .31-.55, P < .0001), and resided in-state compared with out of state (OR .39 CI: .22-.68, P < .05). The top 3 patient self-reported factors influencing nonprogression were fear of complication, financial hardship, and insurance coverage. Conclusions: Multiple patient factors and the self-reported factors of fear of complication and financial hardship influenced progression to bariatric surgery in a U.S. metropolitan population. Bariatric surgeons and centers should consider and address these factors when assessing patients. (Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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