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Factors Leading to Self-Removal from the Bariatric Surgery Program After Attending the Orientation Session

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Abstract

Background

Bariatric surgery orientation sessions are often the first point of contact and a recommended component of pre-bariatric surgery assessment. Self-removal rates after bariatric program orientation are as high as 25 % despite the proven efficacy of this procedure. The objective of this study was to identify factors contributing to patient self-removal after orientation using a mixed method approach.

Methods

Patients who attended the Toronto Western Hospital Bariatric Surgery Program orientation between 2012 and 2013 and then self-removed from the program (N = 216) were included in the study. Subjects were interviewed via telephone using a semi-structured interview guide, generating both quantitative and qualitative data. Factors leading to discontinuation were rated on a five-point Likert scale. Qualitative data was analyzed using constant comparative methodology.

Results

The response rate was 59 % with a 40.7 % completion rate (N = 88). Concerns about potential surgical risks and complications and the ability to adapt to changes in eating and drinking post-operatively were identified as the top two factors for patients’ self-removal from the program. Thematic analysis uncovered 11 major themes related to patient self-removal. Unexpected themes include perceived personal suitability for the surgery, family impact of surgery, miscommunication with the family physician, and fears related to the orientation information.

Conclusions

This is one of the first studies examining barriers to bariatric surgery in the pre-operative setting and offers new insights into the reasons patients self-remove from bariatric surgery programs. This study may inform bariatric orientation program changes resulting in improved access to this effective surgical intervention.

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References

  1. World Health Organization. Obesity and overweight fact sheet N8311. 2006. Available from: http://www.who.int/mediacentre/factsheets/fs311/en

  2. Statistics Canada. Overweight and obesity in children and adolescents: results from the 2009 to 2011 Canadian Health Measures Survey. 2012. Available from: http://www.statcan.gc.ca/pub/82-003-x/2012003/article/11706-eng.htm

  3. Ludwig D, Pollack H. Obesity and the economy: from crisis to opportunity. JAMA. 2002;301(5):533–5.

    Article  Google Scholar 

  4. Pitzul KB, Jackson T, Crawford S, et al. Understanding disposition after referral for bariatric surgery: when and why patients referred do not undergo surgery. Obes Surg. 2014;24(1):134–40.

    Article  PubMed  Google Scholar 

  5. Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  6. Canadian Institute for Health Information. Bariatric surgery in Canada. 2014. Available from: https://secure.cihi.ca/free_products/Bariatric_Surgery_in_Canada_EN.pdf

  7. 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 for Metabolic & Bariatric Surgery. Endocr Pract. 2013;19(2):337–72.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Auspitz M, Cleghorn MC, Azin A, et al. Knowledge and perception of bariatric surgery among primary care physicians: a survey of family doctors in Ontario. Obes Surg 2016 [Epub].

  9. Tsuda S, Barrios L, Schneider B, et al. Factors affecting rejection of bariatric patients from an academic weight loss program. Surg Obes Relat Dis. 2009;5(2):199–202.

    Article  PubMed  Google Scholar 

  10. Sockalingam S, Cassin S, Crawford A, et al. Psychiatric predictors of surgery non-completion following suitability assessment for bariatric surgery. Obes Surg. 2013;23(2):205–11.

    Article  CAS  PubMed  Google Scholar 

  11. Martin M, Beekley A, Kjorstad R, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obest Relat Dis. 2010;6(1):8–15.

    Article  Google Scholar 

  12. DeMaria E, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obest Relat Dis. 2010;6(4):347–55.

    Article  Google Scholar 

  13. Afonso B, Rosenthal R, Li K, et al. Perceived barriers to bariatric surgery among morbidly obese patients. Surg Obest Relat Dis. 2010;6(1):16–21.

    Article  Google Scholar 

  14. Perlman S, Reinhold R, Nadzam G. How do family practitioners perceive surgery for the morbidly obese? Surg Obest Relat Dis. 2007;3(4):428–33.

    Article  Google Scholar 

  15. Gregory D, Temple JN, Twells L. Patients’ perceptions of waiting for bariatric surgery: a qualitative study. Int J Equity Health. 2013;12:86.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Keating C, Backholder K, Moodie M, et al. Differences in the rates of treatment of severe obesity using bariatric surgery across socioeconomic groups. JAMA Surg. 2015;150(4):367–8.

    Article  PubMed  Google Scholar 

  17. Stanford F, Kyle T, Claridy M, et al. The influence of an individual’s weight perception on the acceptance of bariatric surgery. Obesity (Silver Spring). 2015;23(2):277–81.

    Article  Google Scholar 

  18. Merrell J, Ashton K, Windover A, et al. Psychological risk may influence drop-out prior to bariatric surgery. Surg Obest Relat Dis. 2012;8(4):463–9.

    Article  Google Scholar 

  19. Lecaros-Bravo J, Cruzat-Mandich C, Diaz-Castrillon F, et al. Bariatric surgery in adults: variables that facilitate and hinder weight loss from patients perspective. Nutr Hosp. 2015;31(4):1504–12. Spanish.

    PubMed  Google Scholar 

  20. Ide P, Fitzgerald-O’Shea C, Lautz D. Implementing a bariatric surgery program. AORN J. 2013;97(2):195–206.

    Article  PubMed  Google Scholar 

  21. Moffett J. Twelve tips for “flipping” the classroom. Med Teach. 2014;37:1–6.

    Google Scholar 

  22. Fortier MA, Bunzli E, Walthall J, Olshansky E, Saadat H, Santistevan R, Mayes L, Kain ZN. Web-based tailored intervention for preparation of parents and children for outpatient surgery (WebTIPS): formative evaluation and randomized controlled trial.

  23. Parry MJ, Watt-Watson J, Hodnett E, et al. Cardiac Home Education and Support Trial (CHEST): a pilot study. Can J Cardiol. 2009;25(12):e393–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We would like to thank the patients who participated in this study.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada

    Kai Yang

  2. Faculty of Engineering and Applied Science, University of Toronto, Toronto, M5S 1A4, Canada

    Binghao Zhang

  3. Bariatric Surgery Program, Department of General Surgery, Toronto Western Hospital, Toronto, M5T 2S8, Canada

    Patti Kastanias, Wei Wang & Allan Okraniec

  4. Centre for Mental Health, Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada

    Sanjeev Sockalingam

  5. Toronto General Hospital, 200 Elizabeth St-8EN228, Toronto, ON, M5G 2C4, Canada

    Sanjeev Sockalingam

Authors
  1. Kai Yang
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  2. Binghao Zhang
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  3. Patti Kastanias
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  4. Wei Wang
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  5. Allan Okraniec
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  6. Sanjeev Sockalingam
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Corresponding author

Correspondence to Sanjeev Sockalingam.

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Conflict of Interest

Kai Yang, Binghao Zhang, Patti Kastanias, Wei Wang, Allan Okraniec, and Sanjeev Sockalingam declare that they have no conflict of interest related to this work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Yang, K., Zhang, B., Kastanias, P. et al. Factors Leading to Self-Removal from the Bariatric Surgery Program After Attending the Orientation Session. OBES SURG 27, 102–109 (2017). https://doi.org/10.1007/s11695-016-2250-9

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  • DOI: https://doi.org/10.1007/s11695-016-2250-9

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