Bariatric surgeries, such as sleeve gastrectomy, Roux-en-Y gastric bypass, and adjustable gastric band procedures, are among the most effective treatments for morbid obesity and its associated comorbidities. Recent data show that the number of bariatric procedures performed each year has risen greatly during the last decade, with over 250,000 such procedures being performed in the United States each year. Published research has demonstrated markedly improved safety and outcomes after these operations when compared with other common general surgeries. However, with increasing demand for bariatric surgery, a growing number of patients may experience complications after these procedures.
Research Lacking on Post-Surgical Decision Regret
Previous studies have shown that complications following laparoscopic sleeve gastrectomy are rare but can have a negative impact on patient satisfaction. Although some studies have assessed the experiences of patients who have undergone bariatric surgery with respect to QOL, weight loss, or the resolution of comorbidities, research is lacking on decision regret about these procedures, especially among those who experienced perioperative complications. For a study published in Obesity Surgery, Michał R. Janik, MD, PhD, and colleagues assessed whether patients with postoperative complications regretted their decision to undergo laparoscopic sleeve gastrectomy more than those with an uneventful postoperative course. The study compared 21 patients with complications after laparoscopic sleeve gastrectomy with a control group consisting of 69 patients who did not experience any postoperative complications. A telephone survey was used to collect data on patient satisfaction about the decision to undergo surgery using the Decision Regret Scale.
Postoperative Regret Comparable, Regardless of Complications
Results from the study showed that patients in both groups achieved similar percentages of total weight loss and excessive BMI loss when assessed 1 year after surgery. The differences in weight change at 12 months postoperatively were not significant in both groups. The average regret scores in the study and control groups were 13.2±1.2 and 13.3±1.1, respectively, suggesting no significant differences in patients expressing regret between the study and control groups (Table). The percentages of patients with a score higher than 50 on the Decision Regret Scale—which is considered to represent overall regret regarding a patient’s decision—were almost identical in both groups.
Despite the benefits of bariatric surgery, findings suggest there continue to be serious concerns regarding postoperative complications. Surprisingly, patients with postoperative complications reported a similar degree of negative effects after their operation when compared with those who had an uneventful postoperative course. According to Dr. Janik, weight loss had the greatest effect on patients who expressed regret after bariatric surgery.
Preoperative Counseling May Enhance Patient Experiences
Clinical research evaluating patient perspectives on postoperative experiences after bariatric surgery can provide clinicians with valuable information. Results from the study strengthen the current body of evidence showing that weight loss is a significant factor that affects patient satisfaction after bariatric surgery. The data highlight that the regret associated with undergoing sleeve gastrectomy correlates with worse weight loss outcomes than what might be anticipated.
Dr. Janik and colleagues confirmed the complexity of patient experiences after sleeve gastrectomy and highlight the importance of patients’ viewpoints on postoperative courses and evaluations of follow-up outcomes. “Improving preoperative counseling on the management of postoperative expectations is critical to the patient’s objective and subjective success and may lead to more successful outcomes after sleeve gastrectomy,” Dr. Janik says, adding that even patients who experience perioperative complications may not regret their decision to undergo the surgery if the outcome is satisfactory.
Additional studies are needed to analyze the causes of patient dissatisfaction after bariatric surgery more thoroughly, Dr. Janik says, noting that the current study focused only on whether patients regretted their decisions. “However, our findings demonstrated the importance of patient perspectives in bariatric surgery,” he adds. The study team reports that it intends to conduct further research to gain a better understanding of post-surgical dissatisfaction for patients undergoing these procedures.