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

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.