B. Corey1,2, L. Goss1, A. Gullick1,2, D. Breland1, J. Richman1,2, J. Grams1,2 2Birmingham Veteran’s Affairs Medical Center,Surgery,Birmingham, ALABAMA, USA 1University Of Alabama At Birmingham,Surgery,Birmingham, ALABAMA, USA
Introduction: Patient compliance with attendance at follow-up bariatric appointments is associated with increased weight loss, and reasons for low follow-up compliance are poorly understood. The purpose of this study was to investigate the association of patient-related factors with follow-up compliance after laparoscopic Roux-en-Y gastric bypass (LRYGB).
Methods: Retrospective review was conducted of all adult patients who underwent LRYGB from 2005-2013 at a single institution. Patients were stratified by follow-up attendance at a total of 8 possible postoperative visits: low 0-2, intermediate 3-5, and high 6-8 visits. Socioeconomic status was determined using 6 measures compared to national census data to generate a neighborhood Summary Z-score. Patients who attended <50% of follow-up visits were mailed a survey to assess reasons for low compliance. Univariate and multivariate analyses were used to compare patient characteristics and compliance. Statistical significance was determined by p <0.05.
Results: Of 756 patients, there were 241 patients in the low, 327 in the intermediate, and 188 in the high compliance groups. The high compliance group was older (p=0.004), white (p=0.020), and had lower preoperative weight (p=0.008) and BMI (p=0.040). There were no differences in overall socioeconomic characteristics based on compliance. On adjusted multivariate analysis, patients were more likely to attend 1 year follow-up appointment if they were older (OR=1.04, CI 1.02-1.05), of lower socioeconomic status (OR=1.04, CI 1.00-1.08), white (OR=1.5, CI 1.03-2.2), had private insurance (OR=1.6, CI 1.02-2.5), and were present at their last appointment (OR=6.30, CI 4.41-8.95); while patients were more likely to attend 2 year follow-up appointment if they were successful at weight loss (OR=1.03, CI 1.00-1.05), if they had shorter driving distance (50-99 miles, OR=2.2, CI 1.4-3.5; <50 miles, OR=1.6, CI 1.0-2.4), or had attended their previous appointment (OR=4.49, CI 3.15-6.40). On survey, patients reported the primary reason they did not follow up was travel time to the clinic (44%), cost of the visits (28%), commitments at work/school (24%), and because of guilt for not following the diet and exercise plan and/or felt ashamed of regaining weight (24%).
Conclusion: Patient-related factors are predictive of follow-up compliance. Based on self-reported reasons, health behaviors and values influence attendance at postoperative bariatric appointments. Since patients self-report travel time and cost as the two primary reasons for failure to follow up, alternative methods of follow-up should be considered such as appointments using telemedicine technology, follow-up “apps” to self-report progress, or stronger collaboration with local primary care physicians.