title: Understanding disposition after referral for bariatric surgery: when and why patients referred do not undergo surgery.
abstract: BACKGROUND
  Bariatric surgery is an effective long-term solution for weight loss in the severely obese. Prevalence of bariatric surgery has increased over the recent years; however, the attrition rate of those referred who actually undergo surgery is high. The purpose of this study was to examine patients' attrition rates after referral for bariatric surgery at an academic tertiary care institution. When and why patients who were referred for bariatric surgery did not ultimately undergo surgical treatment was examined.
  
  
  METHODS
  Charts of 1,237 patients referred to the Toronto Western Hospital Bariatric Program from program inception to February 2011 were retrospectively reviewed. Patient demographics, appointment dates, no shows and cancellations, and when and why patients did not undergo surgery were summarized.
  
  
  RESULTS
  Patients' mean age was 47. Most patients were female, and the mean body mass index was 47. Half (50.6 %) of the total persons referred left the program prior to being seen by a health-care professional, and only 36.2 % underwent surgical treatment. Only 2.75 % of persons were ineligible for surgery. A total of 60.6 % of persons self-removed from our program. Reasons for self-removal varied, with the most common reason for leaving the program recorded as "unknown."
  
  
  CONCLUSIONS
  Our multidisciplinary program with in-hospital psychosocial resources resulted in very few persons being excluded from receiving surgical treatment. However, less than half of those referred underwent surgery as most persons self-removed from our program for unknown reasons. Further investigation is required to determine which patient, administrative, and system factors play a role in the patients' decision to not undergo bariatric surgical treatment.
authors.forename: Kristen Blythe
authors.initials: KB
authors.lastname: Pitzul
authors.forename: Timothy
authors.initials: T
authors.lastname: Jackson
authors.forename: Sean
authors.initials: S
authors.lastname: Crawford
authors.forename: Josephine Chi Hin
authors.initials: JC
authors.lastname: Kwong
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.forename: Raed
authors.initials: R
authors.lastname: Hawa
authors.forename: David
authors.initials: D
authors.lastname: Urbach
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
mesh_terms: D050110:Bariatric Surgery / Q000523:psychology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery; D010349:Patient Compliance / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012189:Retrospective Studies