title: Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery.
abstract: BACKGROUND
  Long-term multidisciplinary care after bariatric surgery is important for weight maintenance and management of co-morbidities. Despite this, the rate of attendance to follow-up appointments is universally low.
  
  
  OBJECTIVE
  To identify patient factors that contribute to adherence to follow-up care after bariatric surgery.
  
  
  METHODS
  Three university-affiliated hospitals in Canada
  
  
  METHODS
  A cohort study of 388 patients who underwent bariatric surgery from January 2011 to December 2011 was performed. This program mandates multidisciplinary follow-up care at 3, 6, and 12 months, and annually thereafter. Patients' socioeconomic, psychosocial, and medical and psychiatric co-morbidities were recorded prospectively. Adherence to follow-up care was defined as having attended the majority of clinic visits (3 or 4 out of 4); all other patients were considered nonadherent.
  
  
  RESULTS
  The mean age of patients was 45.0 years, 81.2% were female, and the majority underwent a gastric bypass (91.8%) versus a sleeve gastrectomy (8.2%); 62.1% of patients were adherent to follow-up appointments. Patients older than 25 years had a higher adherence rate than those who were younger (63.2% versus 37.5%, P = .040). Patients with full-time or part-time employment had a significantly higher adherence rate than those who were unemployed or retired (65.6% versus 50.0%, P = .017, odds ratio 1.9). Patients with obstructive sleep apnea (OSA) before surgery had higher follow-up adherence than those without OSA (62.2% versus 37.8%, P = .044). In multivariate analysis, employment remained an independent predictor of follow-up adherence (P = .017).
  
  
  CONCLUSIONS
  Employment was the strongest predictor of attendance to follow-up clinic. Patients with OSA and older patients were also more likely to return consistently for scheduled follow-up.
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada; Division of General Surgery, Toronto East General Hospital, Toronto, Canada.
authors.forename: Soroush
authors.initials: S
authors.lastname: Larjani
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada.
authors.forename: Israel
authors.initials: I
authors.lastname: Spivak
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada.
authors.forename: Ming
authors.initials: M
authors.lastname: Hao Guo
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada.
authors.forename: Babak
authors.initials: B
authors.lastname: Aliarzadeh
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Robinson
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.affiliation: The University of Toronto Bariatric Collaborative, Toronto, Canada; Department of Psychiatry, University Health Network, Toronto, Canada. Electronic address: maart@tegh.on.ca.
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Aarts
mesh_terms: D050110:Bariatric Surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010349:Patient Compliance; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Patient compliance; Predictors; Weight loss