title: Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients.
abstract: BACKGROUND
  With bariatric restrictive procedures a major issue is predictors of clinical outcome; non-surgical (compliance) and psychological factors might play a role in long term-results of bariatric surgery. We evaluated a set of predictors of short-term and long-term clinical outcome including psychiatric and psychological variables, as well as measures of post-surgery compliance.
  
  
  METHODS
  172 consecutive patients undergoing laparoscopic adjustable gastric banding (LAGB) with a minimum of 12 months follow-up, were studied; before surgery they were administered the NIMH Diagnostic Interview Schedule (Version III-R, DIS III-R) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (Version 2.0, SCID-II). After surgery, patients were scheduled for visits at 2-week intervals for the first 2 months, at monthly intervals up to 1 year and 3-monthly intervals for 2 years; compliance with diet, rules, physical exercise, plus integrated compliance (sum of scores), and percentage of attendance at scheduled visits were recorded. Patients were contacted again at 36 and at 48 months.
  
  
  RESULTS
  BMI, compliance, percentage of attendance at scheduled visits (positively), and narcissistic personality (negatively) were all associated with weight loss at 12, 24 (and 36 months). Percentage of attendance was also associated at 48 months. At stepwise regression analysis, BMI and integrated compliance predicted weight loss at 12, 24, and 36 months, while percentage of attendance at scheduled visits predicted weight loss at 48 months. Narcissistic personality predicted weight loss only at 12 months.
  
  
  CONCLUSIONS
  Adherence to scheduled visits and compliance to recommended rules, more than personality disorders, predict success of LAGB, at least during the first 4 years.
authors.affiliation: Università degli Studi di Milano and Ospedale San Paolo, Milano, Italy. antonio.pontiroli@unimi.it
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Pontiroli
authors.forename: Andrea
authors.initials: A
authors.lastname: Fossati
authors.forename: Paola
authors.initials: P
authors.lastname: Vedani
authors.forename: Monica
authors.initials: M
authors.lastname: Fiorilli
authors.forename: Franco
authors.initials: F
authors.lastname: Folli
authors.forename: Michele
authors.initials: M
authors.lastname: Paganelli
authors.forename: Monica
authors.initials: M
authors.lastname: Marchi
authors.forename: Cesare
authors.initials: C
authors.lastname: Maffei
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000523:psychology / Q000601:surgery; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery*; D009819:Office Visits; D010349:Patient Compliance / Q000523:psychology*; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome