School of Medicine, University of Utah, Salt Lake City, UT, 84132, USA.
Division of General Surgery, Department of Surgery, University of Utah, 30 N 1900 E, 5R160, Salt Lake City, UT, 84132, USA.
Surg Endosc. 2022 Feb;36(2):936-940. doi: 10.1007/s00464-021-08352-x. Epub 2021 Feb 23.
High rates of attrition to post-bariatric surgical care continue to be common, despite recommendations for lifelong follow-up. There is little available work focusing on the etiology of attrition to post-bariatric surgical follow-up. Patient-reported outcomes (PROs) are metrics of patients' perceptions of their own health and have been used for their predictive value in other specialties. The relationships between PROs and loss to follow-up have not been explored.
PRO data from patients who met the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) definition of loss to follow-up at 1-year postoperatively were reviewed and compared to patients who were compliant with 1-year follow-up. Patient-reported outcomes measurement information system (PROMIS) measures are routinely collected pre- and postoperatively at our institution using a series of validated computer-adaptive tests that assess depression, satisfaction with social roles, pain interference, and physical function. A series of univariate logistic regressions tested whether baseline PROs or change in PROs from baseline to 6-month postoperatively predicted loss to follow-up at 1 year.
Neither baseline PROs nor change in depression, satisfaction with social roles, pain interference, or physical function were significant predictors of loss to follow-up. Similarly, patient state of residence, Charlson Comorbidity Index, BMI, and percent excess weight loss were not significant predictors of follow-up attrition.
The PROs in this study were not significant predictors of loss to follow-up at 1-year postoperatively. The rate of bariatric procedures continues to increase nationally, so does the potential for late post-surgical complications. Given the potential impact of loss to follow-up on adverse late post-surgical outcomes, there is a need to facilitate long-term post-surgical follow-up and more investigation is needed to identify and intervene on underlying causes of bariatric patient follow-up attrition.
尽管建议进行终身随访，但减重手术后仍持续出现较高的失访率。目前针对减重手术随访失访的病因学研究较少。患者报告的结局（PROs）是患者对自身健康感知的指标，已在其他专业领域中用于其预测价值。PROs 与随访失访之间的关系尚未得到探索。
对符合代谢和减重外科认证和质量改进计划（MBSAQIP）术后 1 年随访失访定义的患者的 PRO 数据进行了回顾，并与符合 1 年随访的患者进行了比较。在我们的机构，使用一系列经过验证的计算机自适应测试来常规收集患者报告的结局测量信息系统（PROMIS）测量值，这些测试评估抑郁、社会角色满意度、疼痛干扰和身体功能。一系列单变量逻辑回归检验了基线 PROs 或从基线到术后 6 个月的 PROs 变化是否预测了术后 1 年的随访失访。
基线 PROs 或抑郁、社会角色满意度、疼痛干扰或身体功能的变化均不是随访失访的显著预测因素。同样，患者的居住状态、Charlson 合并症指数、BMI 和超重减轻百分比也不是随访失访的显著预测因素。
本研究中的 PROs 不是术后 1 年随访失访的显著预测因素。全国范围内的减重手术数量持续增加，因此术后晚期并发症的潜在风险也在增加。鉴于随访失访对不良晚期术后结局的潜在影响，需要促进长期术后随访，需要进一步研究以确定和干预减重患者随访失访的根本原因。
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