Introduction:
Preoperative bariatric surgery attrition has been identified as a barrier to effectively treating individuals with morbid obesity and related co-morbidities. Documented by recent studies, attrition rates can range between 25% and 51% (Sala, Haller, Laferrere, Homel, & McGinty, 2017; Pitzul et al., 2014; Diamant et al., 2014). Previous studies have explored barriers to bariatric surgery in eligible populations, however, few studies have investigated patient attrition once accepted onto a programme.
Methods:
The present retrospective cross-sectional study investigated the database of clients referred for surgery at Auckland City hospital (Auckland, New Zealand) from 2007 – 2016. Patients were categorised into those who were a) declined by the medical team, b) accepted for surgery and completed the surgery, and c) those who were accepted for surgery but withdrew from the programme in the preoperative period. Pathways to attrition were categorised as demographic, medical and client-led. Additionally, a qualitative study is underway to explore in fuller detail the experiences of those most likely to withdraw at this stage.
Results:
The results indicated ethnic disparities in attrition rates with clients of Pacific origin being the least likely to follow through with surgery and clients of Caucasian origin being the most likely to follow through with surgery. Other demographic and medical factors associated with completing surgery included being female and employed. The most frequent client-led attrition pathways included ‘unknown’, ‘disengagement’ and ‘voluntary withdrawal’.
Conclusions:
The results extend existing research by focussing on a population that includes Pacific and Maori ethnic representation. The results will serve as an important basis for further investigation into solutions to decreasing attrition. Qualitative research is suggested as one way to further explore the potential interplay of cultural, social, and medical factors associated with preoperative attrition.