Hamid Safraz A, Butensky Samuel D, Graetz Elena, Olivares Miriam, Schwartz Jennifer S, Schneider Eric B, Ghiassi Saber, Gibbs Karen E
Yale University School of Medicine, New Haven, CT, United States.
Yale National Clinician Scholars Program, New Haven, CT, United States.
Obes Surg. 2025 Jun;35(6):2390-2394. doi: 10.1007/s11695-025-07884-8. Epub 2025 Apr 28.
Preoperative attrition from metabolic and bariatric surgery (MBS) programs remains a barrier for a subset of patients seeking surgical treatment of obesity. Prior analyses examining factors associated with attrition have been limited by study samples that are small in number and predominantly non-Hispanic, White. We aimed to assess factors associated with preoperative attrition using a large, racially and ethnically representative study sample.
We reviewed the electronic health record of an urban, academic health system from 2021 to 2024. Our outcome was preoperative attrition, defined as not completing surgery within the study period. We compared individual- and regional-level factors between patients who experienced attrition with those who did not. We accounted for confounding effects using multivariable logistic regression.
Of a total 3043 patients, 28.0% were Black and 31.1% were Hispanic. Compared to patients who completed surgery, those who experienced attrition were older (mean age (SD): 43.9 (12.7) years vs. 41.8 (12.1) years, p < 0.001), were proportionally more likely to have obesity-related diseases (1-3 diseases: 59.3% vs. 55.9%; 3 diseases: 13.1% vs. 9.1%, p < 0.001), and more likely to be insured by Medicare (5.2% vs 2.2%, p < 0.001). Census tract social vulnerability, as measured by the social vulnerability index (SVI), was not associated with attrition (median (IQR) SVI percentile: 0.67 (0.59) vs. 0.59 (0.59), p = 0.071). In adjusted analysis, patients with more than three obesity-related diseases and those insured by Medicare had 53% (aOR 1.53, 95% CI 1.10-2.13) and 94% (aOR 1.94, 95% CI 1.14-3.30) increased odds of experiencing attrition, respectively. Hispanic ethnicity was associated with decreased odds of experiencing attrition (aOR 0.80, 95% CI 0.66-0.97).
Among a large sample of patients racially and ethnically representative of the US population, the presence of more than three obesity-related diseases and Medicare insurance were associated with increased odds of preoperative attrition from an MBS program while Hispanic ethnicity was associated with decreased odds. Future studies should elucidate reasons for attrition and develop strategies to address the factors associated with attrition.
代谢与减重手术（MBS）项目的术前流失率仍是一部分寻求肥胖手术治疗患者的障碍。先前对与流失相关因素的分析受到样本数量少且主要为非西班牙裔白人的研究样本的限制。我们旨在使用一个具有种族和民族代表性的大样本研究来评估与术前流失相关的因素。
我们回顾了2021年至2024年一家城市学术医疗系统的电子健康记录。我们的结局是术前流失，定义为在研究期间未完成手术。我们比较了经历流失的患者与未经历流失的患者在个体和区域层面的因素。我们使用多变量逻辑回归来考虑混杂效应。
在总共3043名患者中，28.0%为黑人，31.1%为西班牙裔。与完成手术的患者相比，经历流失的患者年龄更大（平均年龄（标准差）：43.9（12.7）岁对41.8（12.1）岁，p<0.001），患肥胖相关疾病的比例更高（1 - 3种疾病：59.3%对55.9%；3种疾病：13.1%对9.1%，p<0.001），并且更有可能由医疗保险承保（5.2%对2.2%，p<0.001）。用社会脆弱性指数（SVI）衡量的人口普查区社会脆弱性与流失无关（SVI百分位数中位数（四分位间距）：0.67（0.59）对0.59（0.59），p = 0.071）。在调整分析中，患有三种以上肥胖相关疾病的患者和由医疗保险承保的患者经历流失的几率分别增加了53%（调整后比值比1.53，95%置信区间1.10 - 2.13）和94%（调整后比值比1.94，95%置信区间1.14 - 3.30）。西班牙裔与经历流失的几率降低相关（调整后比值比0.80，95%置信区间0.66 - 0.97）。
在一个具有美国人口种族和民族代表性的大样本患者中，患有三种以上肥胖相关疾病和医疗保险与MBS项目术前流失几率增加相关，而西班牙裔与流失几率降低相关。未来的研究应阐明流失的原因，并制定策略来解决与流失相关的因素。
