Factors Associated with Preoperative Attrition from a Large, Racially and Ethnically Representative Bariatric Program in the USA: A Single-Center Retrospective, Cohort Study.

IF 2.9 3区 医学 Q1 SURGERY
Obesity Surgery Pub Date : 2025-06-01 Epub Date: 2025-04-28 DOI:10.1007/s11695-025-07884-8
Safraz A Hamid, Samuel D Butensky, Elena Graetz, Miriam Olivares, Jennifer S Schwartz, Eric B Schneider, Saber Ghiassi, Karen E Gibbs
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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

美国一项具有种族和民族代表性的大型减肥计划的术前减员相关因素:一项单中心回顾性队列研究
背景:代谢和减肥手术(MBS)计划的术前消耗仍然是一部分寻求手术治疗肥胖患者的障碍。由于研究样本数量少,而且主要是非西班牙裔白人,先前的分析研究了与磨耗相关的因素。我们的目的是评估与术前磨耗相关的因素,使用一个大的、具有种族和民族代表性的研究样本。方法:回顾某城市学术卫生系统2021 - 2024年的电子健康记录。我们的结果是术前损耗,定义为在研究期间未完成手术。我们比较了个体和地区层面的因素在经历过磨耗的患者和没有经历过磨耗的患者之间。我们使用多变量逻辑回归解释了混杂效应。结果:3043例患者中,28.0%为黑人,31.1%为西班牙裔。与完成手术的患者相比,经历磨损的患者年龄较大(平均年龄(SD): 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),更有可能参加医疗保险(5.2%对2.2%,p < 0.001)。以社会脆弱性指数(SVI)衡量的人口普查区社会脆弱性与流失无关(中位数(IQR) SVI百分位数:0.67 (0.59)vs. 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接受医疗保险的患者经历减员的几率分别增加53% (aOR 1.53, 95% CI 1.10-2.13)和94% (aOR 1.94, 95% CI 1.14-3.30)。西班牙裔与经历磨耗的几率降低相关(aOR 0.80, 95% CI 0.66-0.97)。结论:在具有美国人口种族和民族代表性的大量患者样本中,存在三种以上肥胖相关疾病和医疗保险与MBS计划术前磨损的几率增加相关,而西班牙裔种族与风险降低相关。未来的研究应该阐明员工流失的原因,并制定策略来解决与员工流失相关的因素。
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来源期刊
Obesity Surgery
Obesity Surgery 医学-外科
CiteScore
5.80
自引率
24.10%
发文量
567
审稿时长
3-6 weeks
期刊介绍: Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.
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