Type of Document Thesis Author Johnell, Patrice Author's Email Address email@example.com URN etd-07112009-154926 Title Characteristics of Bariatric Surgery Patients Lost to Follow-up Degree Master of Science Department Nursing, School of Advisory Committee
Advisor Name Title Laurie Grubbs Committee Chair Deborah Frank Committee Member Mary Beth Zeni Committee Member Keywords
- Gastric Bypass
- Patient Adherence
- Follow-Up Compliance
- Bariatric Surgery
- Morbid Obesity
- Center of Excellence
Date of Defense 2009-07-09 Availability unrestricted AbstractBackground: Patients who become lost to follow-up after bariatric surgery are “status unknown”
and could be at risk for complications known to occur months and years after surgery. Bariatric
programs stand to lose their designations as centers of excellence (COE) if patient follow-up
does not meet COE requirements. Many programs are struggling to improve their follow-up
rates, but little is known about the “lost” patient and what prompts them to terminate care. This research seeks to identify factors associated with patients who are lost to follow-up compared to patients who are not lost to follow-up.
Methods: The records of consecutive patients who underwent a laparoscopic Roux-en-Y gastric
bypass (GBP) or an adjustable gastric banding procedure (AGB) in a single-surgeon practice,
between 2004 and 2007 were reviewed. Patients were divided into LOST and NOT LOST
subgroups. Patients were considered LOST if they had not had an office visit for at least 18
months or more, otherwise they were counted as NOT LOST. The convenience sample of 368
patients was stratified into surgery type, and a randomized sample was derived from the
prohibitively large NOT LOST AGB cohort for the final analysis. For statistical purposes, the
sample of observed cases (n=253) was weighted to account for the unobserved subjects.
Surgery type, age, gender, marital status, children 12 years of age or younger in the home,
employment status, payment type, body mass index, goal weight, travel distance and mean
quality of life score on a seven-question assessment tool were analyzed as possible predictors of LOST using logistical regression analysis.
Results: The observed study group was comprised of 253 subjects, 85 GBP patients and 168 AGB
patients; 85.1 % female and 14.9% male. Over a third of patients met criteria for LOST (36.1%).
In the non-weighted logistic regression, statistically significant odds ratios were found for the dependent variable of LOST and coefficients of GBP (p=0.003), male gender (p=0.018), age group 45-54 (p=0.028) and lowest mean score on QOL assessment (p=0.039) (95% confidence level; p<0.05). In the weighted sample (n=368), the odds ratio for the coefficient GBP was 6.08 (p< 0.0001) with a 95% confidence interval (CI; 3.94, 9.37); for the coefficient of age 45-54 years the odds ratio was 2.19 (p=0.048) with a 95% confidence interval (CI; 1.01, 4.75).
Conclusion: Gastric bypass, male gender, middle age and low quality of life may be risk factors
for lost to follow-up after bariatric surgery. Travel distance, payment type, marital status,
employment status, children 12 years of age or younger living in the home, preoperative BMI, and self-reported goal weight may not be risk factors associated with lost to follow-up.
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