Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California.
Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.
J Surg Res. 2022 Aug;276:54-75. doi: 10.1016/j.jss.2022.01.023. Epub 2022 Mar 22.
Bariatric surgery (BS) has been shown to effectively treat morbid obesity and improve obesity-related comorbidities. Nonetheless, BS remains underutilized among qualified patients.
PubMed, SCOPUS, and OVID databases were searched to identify published comparative studies examining BS referral patterns. Data on barriers to BS referrals were examined and summarized.
Barriers to referrals stemmed largely from a lack of familiarity with safety, efficacy, and postoperative care amongst providers. Providers with previous referrals were more likely to report higher knowledge, comfort in referring patients, and ability to provide postoperative care. Provider initiated discussion of BS was positively associated with referrals. Female and younger patients were more likely to receive referrals. Furthermore, access to appropriate peri-operative resources, local bariatric programs, and insurance eligibility were associated with referral rates. Encouragingly, providers across specialties report eagerness to gain exposure and training in BS.
Lack of provider familiarity with BS efficacy, safety and postoperative care likely contributes to low utilization rates of BS. Further potential barriers in access to BS are logistic factors such as insurance coverage, limited local perioperative resources, and clinic time constraints for patient counseling. Promotion of BS amongst providers and both surgical and non-surgical trainees will likely have a significant impact on referral rates and access to this life-saving procedure. Future studies should further investigate the barriers to BS and delineate the effect size of each barrier on referral rates to efficiently increase access.
减重手术（BS）已被证明可有效治疗病态肥胖症并改善肥胖相关合并症。尽管如此，合格患者中 BS 的应用仍不足。
检索 PubMed、SCOPUS 和 OVID 数据库，以确定已发表的比较研究 BS 转诊模式的研究。检查并总结了 BS 转诊的障碍数据。
转诊障碍主要源于提供者对 BS 的安全性、疗效和术后护理缺乏了解。有过转诊经验的医生更有可能报告更高的知识水平、对转诊患者的舒适度以及提供术后护理的能力。提供者主动讨论 BS 与转诊呈正相关。女性和年轻患者更有可能获得转诊。此外，获得适当的围手术期资源、当地的减重计划和保险资格与转诊率有关。令人鼓舞的是，各专业的提供者都报告愿意接受 BS 的培训。
提供者对 BS 的疗效、安全性和术后护理缺乏了解可能是 BS 利用率低的原因。进一步的潜在障碍是获得 BS 的后勤因素，如保险覆盖范围、有限的当地围手术期资源以及为患者咨询提供的诊所时间限制。在提供者和手术及非手术培训人员中推广 BS 可能会对转诊率和获得这种救命手术的机会产生重大影响。未来的研究应进一步调查 BS 的障碍，并确定每个障碍对转诊率的影响大小，以有效地增加机会。
