Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, A-1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
Obes Surg. 2023 Sep;33(9):2874-2883. doi: 10.1007/s11695-023-06761-6. Epub 2023 Aug 4.
Populations most affected by obesity are not reflected in the patients who undergo bariatric surgery. Gaps in the referral system have been studied, but there is a lack of literature investigating obstacles patients encounter after first contact with bariatric surgery clinics. We aim to identify patient populations at risk for attrition during bariatric surgery evaluation and determine patient reported barriers to bariatric surgical care.
This study was a single institution, retrospective, mixed methods study from 2012 to 2021 comparing patients who underwent bariatric surgery to those that withdrew. Surveys were performed of patients who withdrew, collecting information on patient knowledge, expectations, and barriers.
This study included 5982 patients evaluated in bariatric surgery clinic. Those who attained bariatric surgery (38.8%) were more likely to be White (81.2 vs. 75.6%, p<0.001), married (48.5 vs. 44.1%, p=0.004), and employed full time (48.2 vs. 43.8%, p=0.01). They were less likely to live in an area with low income (37.1 vs. 40.7%, p=0.01) or poverty (poverty rate 15.8 vs. 17.4, p<0.001). Of the 280 survey respondents, fear of complications, length of insurance approval process, and wait time between evaluation and surgery were the most reported barriers.
Patients who undergo bariatric surgery were more likely to be White, married, employed full time, and reside in more resourced environments which is not reflective of communities most affected by obesity. The complexity of insurance coverage requirements was a major barrier to bariatric surgery and should be a focus of future healthcare reform.
接受减重手术的患者并不能反映出受肥胖影响最大的人群。已经研究了转诊系统中的差距，但缺乏关于患者在首次接触减重手术诊所后所遇到障碍的文献。我们旨在确定在减重手术评估过程中流失风险较高的患者人群，并确定患者报告的减重手术护理障碍。
这是一项 2012 年至 2021 年期间的单机构回顾性混合方法研究，比较了接受减重手术和退出手术的患者。对退出手术的患者进行了调查，收集了患者知识、期望和障碍的信息。
这项研究纳入了 5982 名在减重手术诊所接受评估的患者。接受减重手术的患者（38.8%）更可能是白人（81.2%比 75.6%，p<0.001）、已婚（48.5%比 44.1%，p=0.004）和全职就业（48.2%比 43.8%，p=0.01）。他们更不可能生活在低收入地区（37.1%比 40.7%，p=0.01）或贫困地区（贫困率为 15.8%比 17.4%，p<0.001）。在 280 名接受调查的患者中，对并发症的恐惧、保险审批过程的长短以及评估和手术之间的等待时间是报告最多的障碍。
接受减重手术的患者更可能是白人、已婚、全职就业，并且居住在资源更丰富的环境中，这与受肥胖影响最大的社区并不相符。保险覆盖范围要求的复杂性是减重手术的一个主要障碍，应成为未来医疗改革的重点。
