Bariatric surgery in patients with bipolar spectrum disorders: Selection factors, postoperative visit attendance, and weight outcomes.
BACKGROUND
As many as 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder.


OBJECTIVE
1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator and 2) to examine surgical outcomes of patients with bipolar spectrum disorders.


METHODS
Academic medical center, United States.


METHODS
A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n = 42) were compared with patients with a bipolar spectrum disorder who were not approved (n = 31) and to matched control surgical patients without a bipolar spectrum diagnosis (n = 29) on a variety of characteristics and surgical outcomes.


RESULTS
Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalization than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years postsurgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n = 21 for bipolar; n = 24 for matched controls) and at 2 or more years (mean = 51 mo; n = 11 for bipolar; n = 20 for matched controls).


CONCLUSIONS
Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years postsurgery. Carefully screened patients with bipolar disorder who engage in long-term follow-up care may benefit from bariatric surgery.
Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Psychiatry & Behavioral Science, Duke University Medical Center, Durham, NC, USA.
Kelli E
KE
Friedman
Department of Psychiatry & Behavioral Science, Duke University Medical Center, Durham, NC, USA.
Katherine
K
Applegate
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Dana
D
Portenier
Department of Psychiatry & Behavioral Science, Duke University Medical Center, Durham, NC, USA. Electronic address: megan.mcvay@duke.edu.
Megan A
MA
McVay
D000328:Adult; D050110:Bariatric Surgery / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011581:Psychological Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
Adherence; Bariatric surgery; Bipolar disorder; Weight loss