Predictors for Adherence to Multidisciplinary Follow-Up Care after Sleeve Gastrectomy
- 156 Downloads
A considerable proportion of patients who undergo bariatric surgeries (BS) do not attend routine postoperative follow-up despite recommendations for such. Data are sparse regarding the various aspects of patient adherence to consultations following sleeve gastrectomy (SG).
To examine predictors of adherence to SG follow-up, reasons for attrition from follow-up, and the relationship between adherence to follow-up and weight loss results.
A retrospective cohort study was performed with a mean follow-up of 3 years. Data were collected from electronic medical records and telephone questionnaires. Adherence was defined both as a numerical variable (ranking 0–9 according to the number of pre-scheduled postoperative visits) and as a dichotomous variable (adherent and non-adherent groups).
Of 178 patients, 46.63% were defined as “adherent,” according to the dichotomous definition. Compared to the “non-adherent group,” patients in the “adherent group” more regularly used vitamin D after the surgery, had fewer rehospitalizations, and reported a lower intake of sweetened beverages. The main reasons for attrition were work-related and difficulties in mobility. Adherence to postoperative follow-up was not found to be correlated to weight loss. Older age (OR = 1.04; p = 0.026) and postoperative side effects (OR = 2.33; p = 0.035) were found to be positive predictors for adherence, whereas rehospitalizations (OR = 0.08; p = 0.028) and ethnical minority status were negative predictors (OR = 0.42; p = 0.019).
Adherence to postoperative follow-up was found to be associated with positive lifestyle behaviors; however, no correlation was found to mid-term weight loss outcomes.
KeywordsSleeve gastrectomy Bariatric surgery Adherence Follow-up Predictors of adherence Reasons for attrition
This study was undertaken as part of the requirements for the MPH degree of Mrs. Ariela Goldenshluger, supervised by Prof. Lital Keinan-Boker, from the Faculty of Medicine of Tel-Aviv-University, Israel, and Dr. Ram Elazary from the Department of General Surgery, at Hadassah-Hebrew University Medical Center.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Boards of the Hadassah-Hebrew University Medical Center, Jerusalem, and Tel-Aviv University, Israel.
For this type of study, formal consent is not required.
- 1.McGrice M, Don PK. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions. Diabetes Metab Syndr Obes. 2015;8:263–74. Available from: https://www.dovepress.com/interventions-to-improve-long-term-weight-loss-in-patients-following-b-peer-reviewed-fulltext-article-DMSO CrossRefPubMedPubMedCentralGoogle Scholar
- 2.British Obesity and Metabolic Surgery Society. BOMSS guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery [Internet]. 2014 [cited 2018 May 13]. Available from: http://www.bomss.org.uk/wpcontent/uploads/2014/09/BOMSS-guidelines-Final-version1Oct14.pdf.
- 3.Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society f. Obesity (Silver Spring). 2013;21 Suppl 1(SUPPL. 1):S1–27.CrossRefGoogle Scholar
- 6.Ministry of Health. Bariatric surgery registry of the Ministry of Health [Internet] [cited 2017 Aug 21]. Available from: http://www.health.gov.il/PublicationsFiles/bariatric_2014.pdf.
- 7.Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2015; Available from: doi: https://doi.org/10.1016/j.clnu.2015.02.012
- 9.Schwoerer A, Kasten K, Celio A, Pories W, Spaniolas K. The effect of close postoperative follow-up on co-morbidity improvement after bariatric surgery. Surg Obes Relat Dis. 2016;1–6. Available from: doi: https://doi.org/10.1016/j.soard.2017.03.024
- 11.Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–52.Google Scholar
- 24.Sherf Dagan S, Keidar A, Raziel A, Sakran N, Goitein D, Shibolet O, et al. Do bariatric patients follow dietary and lifestyle recommendations during the first postoperative year? Obes Surg. 2017;27(9):2258–71.Google Scholar
- 31.NIH conference. Gastrointestinal Surgery for severe obesity. Consensus development conference panel. Ann Intern Med 1991;115(12):956–61.Google Scholar
- 38.Saif T, Strain GW, Dakin G, Gagner M, Costa R, Pomp A. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8(5):542–547. Available from: doi: https://doi.org/10.1016/j.soard.2012.01.013
- 39.Moizé V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-en-Y gastric bypass in a Mediterranean population. J Acad Nutr Diet. 2013;113(3):400–410. Available from: doi: https://doi.org/10.1016/j.jand.2012.11.013
- 40.Ben-porat T, Elazary R, Goldenshluger A, et al. Nutritional deficiencies four years after laparoscopic sleeve gastrectomy—are supplements required for a lifetime? Surg Obes Relat Dis. 2017;1–7. Available from: doi: https://doi.org/10.1016/j.soard.2017.02.021.