Abstract
Purpose
In spite of widespread recommendations for lifelong patient follow-up with a bariatric provider after bariatric surgery, attrition to follow-up is common. Over the past two decades, many programs have sought to expand access to care for patients lacking insurance coverage for bariatric surgery by offering “self-pay” packages; however, the impact of this financing on long-term follow-up is unclear. We sought to determine whether payer status impacts loss to follow-up within 1 year after bariatric surgery.
Materials and Methods
Records of 554 consecutive patients undergoing bariatric surgery who were eligible for 1-year post-surgical follow-up between 2014 and 2019 were retrospectively reviewed. Multiple logistic regression examined the relationship between demographics, psychological variables, payer status, and loss to follow-up.
Results
Self-pay status more than tripled the odds of loss to follow-up (OR = 3.44, p < 0.01) at 1 year following surgery. Males had more than double the odds of attrition (OR = 2.43, p < 0.01), and members of racial and ethnic minority groups (OR = 2.51, p < 0.05) were more likely to experience loss.
Conclusions
Self-pay patients, males and members of racial and ethnic minority groups, may face additional barriers to long-term access to postoperative bariatric care. Further investigation is greatly needed to develop strategies to overcome barriers to and disparities in long-term post-surgical care for more frequently lost groups.
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Acknowledgments
The authors wish to acknowledge our patients and their families, from whom we are continually learning, and all those who advocate for and provide quality care to patients with obesity.
Funding
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002538.
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Drs. Ibele, McGarrity, Volckmann, and Morrow and Ms. Kohler, Martinez, and Turner have no active or potential personal business or financial conflicts of interest related to the enclosed research. Ms. Martinez previously served part time as site coordinator for a clinical trial conducted by the Rhythm Pharmaceuticals which was unrelated to the content of this work.
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Institutional Review Board approval was obtained prior to the conduct of this research. As this was a retrospective study, informed consent for research participation was deemed exempt by our Institutional Review Board. This work has not been previously published, and consent to submit has been received from all co-authors and responsible authorities at the institution where this work has been carried out. 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.
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Martinez, P.L., McGarrity, L.A., Turner, N.A. et al. Self-Pay Payer Status Predicts Long-Term Loss to Follow-Up After Bariatric Surgery. OBES SURG 31, 1590–1596 (2021). https://doi.org/10.1007/s11695-020-05161-4
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DOI: https://doi.org/10.1007/s11695-020-05161-4