title: Patient predictors of follow-up care attendance in Roux-en-Y gastric bypass patients.
abstract: BACKGROUND
  Multidisciplinary care after bariatric surgery is important for long-term safety and optimal weight loss, yet many patients do not attend follow-up appointments. We sought to identify demographic, psychosocial, and weight-related variables that were associated with medical and behavioral health appointment attendance after bariatric surgery.
  
  
  METHODS
  A retrospective chart review was conducted with consecutive patients (n=538) obtaining first-time Roux-en-Y gastric bypass surgery between August 2009 and August 2010. Demographic and psychosocial data were compared between high (>50%) and low (≤50%) medical appointment attendees and high (>50%) and low (≤50%) behavioral health group attendees in their first postoperative year. Percentage excess weight loss at 6 months after surgery was evaluated as a predictor of 12-month appointment attendance.
  
  
  RESULTS
  High medical appointment attendees were more likely to be older, be Caucasian, and have lower phobic anxiety than low medical appointment attendees. High behavioral health attendees had shorter travel distance to the clinic and lower levels of hostility, anxiety, and phobic anxiety compared with low attendees. In multivariate analyses, race/ethnicity and phobic anxiety remained significant predictors of medical attendance, while travel distance to clinic predicted behavioral health attendance. Six-month percent excess weight loss predicted medical appointment attendance at 12 months.
  
  
  CONCLUSIONS
  The identified predictors of poor attendance at medical and behavioral bariatric surgery follow-up appointments should inform efforts to increase follow-up and improve surgical outcomes.
authors.affiliation: Duke University Medical Center, Department of Medicine, Durham, North Carolina; Durham VA Medical Center, Center for Health Services Research in Primary Care, Durham, North Carolina. Electronic address: Megan.mcvay@duke.edu.
authors.forename: Megan A
authors.initials: MA
authors.lastname: McVay
authors.forename: Kelli E
authors.initials: KE
authors.lastname: Friedman
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Applegate
authors.forename: Dana D
authors.initials: DD
authors.lastname: Portenier
mesh_terms: D000328:Adult; D000367:Age Factors; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001294:Attitude to Health; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods* / Q000523:psychology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors
keywords: Bariatric surgery; Behavioral health; Follow-up care; Patient adherence