Predictors of patient selection in bariatric surgery.

Predictors of patient selection in bariatric surgery. Research Abstract Details 

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Predictors of patient selection in bariatric surgery. Abstract Text:

Heena P Santry,Diane S Lauderdale,Kathleen A Cagney,Paul J Rathouz,John C Alverdy,Marshall H Chin,

OBJECTIVE: To identify sociodemographic and clinical predictors of patient selection in bariatric surgery. SUMMARY BACKGROUND DATA: Population-based studies suggest that bariatric surgery patients are disproportionately privately insured, middle-aged white women. It is uncertain whether such disparities are due to surgeon decisions to operate, differences among morbidly obese individuals in access to surgery, or patients' personal preferences regarding surgical treatment. METHODS: We conducted a national survey of 1343 U.S. bariatric surgeons. The questionnaire contained clinical vignettes generated using a balanced fractional factorial design. For each of 3 hypothetical patients unique in age, race, gender, body mass index (BMI), comorbidities, social support, functional status, and insurance, respondents were asked if they would operate. Logistic regression was used to determine the odds of selection for each characteristic while controlling for the other 7 characteristics. Subset analyses were also performed using combinations of BMI and comorbidities. RESULTS: A total of 62.5% of eligible surgeons responded (n = 820). Patient race did not influence surgeon decisions to operate. Hypothetical patient age, BMI, and social support were most influential. In the subgroup of patients who did not meet current NIH BMI and comorbidity criteria for bariatric surgery, male sex (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.14-0.76) was associated with decreased odds of selection. Overall, younger age (OR, 0.09; 95% CI, 0.07-0.11), older age (OR, 0.70; 95% CI, 0.56-0.90), limited functional status (OR, 0.66; 95% CI, 0.52-0.82), poor social support (OR, 0.37; 95% CI, 0.30-0.47), self-pay (OR, 0.72; 95% CI, 0.57-0.91), and public insurance (OR, 0.54; 95% CI, 0.43-0.67) were associated with decreased odds of selection. BMI and comorbidity criteria influenced the magnitude of these effects. CONCLUSIONS: Patient race did not play a role in surgeon decisions to operate. Further research should examine the roles of unequal access to bariatric surgery and differing socio-cultural perceptions of morbid obesity on racial disparities. The influence of patient age, gender, insurance status, social support, and functional status on decisions to operate was mitigated by BMI and comorbidities. Policy-makers currently debating BMI and comorbidity criteria for bariatric surgery should also consider guidelines pertaining to these sociodemographic issues that influence patient selection in bariatric surgery.

Predictors of patient selection in bariatric surgery. Publishing Authors By Initials

HP Santry,DS Lauderdale,KA Cagney,PJ Rathouz,JC Alverdy,MH Chin,

For similar geographic locations: americas: north america: united states research abstracts see: geographic locations: americas: north america: united states research

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Predictors of patient selection in bariatric surgery. Journal Published:

PUBLICATION TYPE: Research Support, Non-U.S. Gov

Journal: Annals of surgery

VOLUME: 245

Page Numbers: 59-67

Journal Abbreviation: Ann. Surg.

ISSN: 0003-4932

DAY: 3

MONTH: Jan

YEAR: 2007

Predictors of patient selection in bariatric surgery. Information

Number of References:

LANGUAGE: eng

NlmUniqueID: 372354

Predictors of patient selection in bariatric surgery. Keywords Mesh Terms:

KEYWORDS: United States

MESH TERMS: surgery

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Grant and Affiliation Information for Predictors of patient selection in bariatric surgery.

AFFILIATION: Department of Surgery, University of Chicago, Chicago, IL 60637, USA. hpatel@surgery.bsd.uchicago.edu

Country: United States

AGENCY: United States NIA

GRANT: P30 AG-12857-08

ACRONYM: AG

MEDLINETA: Ann Surg

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