ArticleSurgical endoscopy2020
The hidden cost of an extensive preoperative work-up: predictors of attrition after referral for bariatric surgery in a universal healthcare system.
Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 34 citations in OpenAlex.
- Preoperative Use of a Mobile Application Within the Multidisciplinary Team Approach - A Randomized Controlled Clinical Trial.Obesity surgery · 2026Trial
- Analysis of morbid obese diabetic and non-diabetic patients: clinical and social characteristics, habits and workup to undergo bariatric surgery in Lombardy, Italy.Acta diabetologica · 2026Article
- Barriers to bariatric surgery completion: A narrative review of preoperative attrition and its determinants.Turkish journal of surgery · 2026Article
- Preoperative Patient Attrition in Metabolic Bariatric Surgery: A Retrospective Monocentric Study.Obesity surgery · 2025Article
- Preoperative Follow-up in Bariatric Surgery: Why They Give Up? Rate, Causes, and Economic Impact of Dropout.Obesity surgery · 2023Article
- Bariatric Patient Engagement in a Pre-surgery Virtual Patient Navigation Platform (VPNP).Obesity surgery · 2023Article
- A study analyzing outcomes after bariatric surgery by primary language.Surgical endoscopy · 2023Observational
- Low Adherence to Bariatric Surgery Program Among Different Races.Obesity surgery · 2023Article
- Advice of General Practitioner, of Surgeon, of Endocrinologist, and Self-determination: the Italian Road to Bariatric Surgery.Obesity surgery · 2022Article
- Does the socio-demographic profile of patients limit access to bariatric surgery?Eating and weight disorders : EWD · 2022Article
- The Effects of the Affordable Care Act on Utilization of Bariatric Surgery.Obesity surgery · 2021Article
- Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery.Surgical endoscopy · 2021Article
- Comparison of 4-Year Health Care Expenditures Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.JAMA network open · 2021Article
- Effect of SARS-CoV-2 (COVID-19) Pandemic and Lockdown on Body Weight, Maladaptive Eating Habits, Anxiety, and Depression in a Bariatric Surgery Waiting List Cohort.Obesity surgery · 2021Article
- Association Between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients With Diabetes and Obesity.JAMA network open · 2021Article
- Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada.JAMA surgery · 2020Article
- Earlier Provision of Gastric Bypass Surgery in Canada Enhances Surgical Benefit and Leads to Cost and Comorbidity Reduction.Frontiers in public health · 2020Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBariatric surgery is in high demand and patients generally undergo an extensive work-up process to maximize the success of surgery, especially in universal healthcare systems. Although valuable, this work-up process can lead to attrition before surgery. Therefore, we aim to assess patient and health system factors associated with attrition after bariatric surgery referral in a universal healthcare system.
methodsThis was a population-based study of all patients aged ≥ 18 referred for bariatric surgery in Ontario, Canada from 2009 to 2015. Primary outcome was patients who dropped out of bariatric surgery after referral. Predictors of attrition after referral included patient demographics, clinical, institutional, and socioeconomic variables. Odds ratios and 95% CIs were estimated by multilevel logistic regression models.
resultsFrom 17,703 patients that were referred for bariatric surgery, 4122 patients dropped after the initial referral. Male patients, increasing age, and longer wait times for surgery were significantly (P < 0.0001) associated with higher odds of attrition. Additionally, smoker status, immigration status, unemployment, and disability were significant factors (P < 0.0001) predicting attrition. Patients who lived in lowest income quintile neighborhoods, when compared to those from the richest neighborhoods, had significantly higher odds of attrition (P = 0.02). Sleep apnea was associated with lower odds of attrition while diabetes and heart failure both with higher odds of attrition.
conclusionEven in a universal healthcare system, there are various factors that could lead to increased odds of attrition before bariatric surgery. Clear disparities exist for certain marginalized populations. Further studies are warranted to ensure equitable utilization of bariatric surgery for all patients.
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