“Bariatric surgery is one component of many in the treatment of obesity and is part of a multidisciplinary, comprehensive care model,” explains Amin Setarehdan, MD. “In patients who undergo these surgeries, preoperative orientation and education and postoperative follow-up and multidisciplinary evaluations are critical. Multidisciplinary follow-up care can play an essential role in preventing adverse outcomes by facilitating early detection and treatment of medical complications.”

Despite the advantages of bariatric surgery, patient adherence rates to postoperative follow-up visits are suboptimal for some individuals. Attrition rates range widely depending on patient attributes, operative procedural characteristics, and the type of specialized exams conducted by multidisciplinary programs, among other factors. “A considerable proportion of patients do not attend routine post-bariatric surgery visits,” Dr. Setarehdan says. “Identifying significant factors of patient adherence to post-surgical follow-up visits could help health program developers adjust their strategies to maximize benefits for patients.”

Several Factors Linked to Higher Non-Adherence Risk

For a retrospective cohort study published in Obesity Surgery, Dr. Setarehdan and colleagues explored the effects of patients’ baseline status, demographic factors, comorbidities, type of surgery, and complications on adherence to a follow-up program in the first year after bariatric surgery and beyond. They followed 5,245 patients who underwent bariatric surgery during 2009-2019, with a median follow-up of 2 years.

“Patients with some characteristics were at higher risk for non-adherence to postoperative follow-ups and were therefore more exposed to serious post-surgical complications,” says Dr. Setarehdan. “Overall, higher BMI at the first visit, a history of dyslipidemia, admission to a public hospital, and gastric bypass surgeries were factors associated with increased adherence [Table]. However, an increased length of stay in the hospital and a history of smoking decreased adherence in the first year and beyond the first year. In addition, male patients with higher education and a history of cardiovascular disease were less likely to attend postoperative visit sessions beyond the first year.”

Specifically, patients undergoing one-anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) in the first year of follow-up were 33% more likely to attend follow-up visits than those undergoing sleeve surgery. Hospital stays of 2 or more days decreased adherence by about 40% when compared with 1-day stays. In the follow-up period beyond the first year of surgery, hospital stays of more than 3 days increased adherence to post-surgical follow-up visits by 64% when compared with 1-day stays. Adherence among those undergoing OAGB or RYGB was also 100% higher than what was seen for those receiving gastric sleeve surgery. Comorbidities did not appear to significantly affect patients’ adherence to the predefined follow-up schedules.

Predictors to Increased Postoperative Care Attendance

According to Dr. Setarehdan, predicting which patients undergoing bariatric surgery are less likely to attend postoperative follow-up visits can help physicians adopt supportive approaches to reduce this detriment. “Findings from our study can be used to help increase attendance at postoperative care by identifying factors that could potentially reduce adherence in each patient,” he says. “People who are likely to miss their visits should be targeted by varied, more intensive recall approaches. Efforts to plan simultaneous multidisciplinary visits may further increase adherence to postoperative visits after bariatric surgery.”

The study offers valuable insights into factors associated with adherence in the first postoperative year and beyond in patients undergoing bariatric surgery, and Dr. Setarehdan says additional research is planned. “In future research, we’re going to compare the results of all valuable outcomes associated with bariatric surgery—including weight loss, improvement in or remission of obesity-related diseases, and treatment failure—in patients with optimal and suboptimal adherence to post-surgical visits to increase our understanding of the influence of these factors.”