Barriers to bariatric surgery: Factors influencing progression to bariatric surgery in a U.S. metropolitan area

Background: Bariatric surgery is an effective and durable treatment for obesity. However, the number of patients that progress to bariatric surgery after initial evaluation remains low. Objectives: The purpose of this study was to identify factors influencing a qualified patient's successful progression to surgery in a U.S. metropolitan area. Setting: Academic, university hospital. Methods: A single-institution retrospective chart review was performed from 2003 to 2016. Patient demographics and follow-up data were compared between those who did and did not progress to surgery. A follow-up telephone survey was performed for patients who failed to progress. Univariate analyses were performed and statistically significant variables of interest were analyzed using a multivariable logistic regression model. Results: A total of 1102 patients were identified as eligible bariatric surgery candidates. Four hundred ninety-eight (45%) patients progressed to surgery and 604 (55%) did not. Multivariable analysis showed that patients who did not progress were more likely male (odds ratio [OR] 2.2 confidence interval [CI]: 1.2–4.2, P <.05), smokers (OR 2.4 CI: 1.1–5.4, P <.05), attended more nutrition appointments (OR 2.1 CI: 1.5–2.8, P <.0001), attended less total preoperative appointments (OR.41 CI:.31–.55, P <.0001), and resided in-state compared with out of state (OR.39 CI:.22–.68, P <.05). The top 3 patient self-reported factors influencing nonprogression were fear of complication, financial hardship, and insurance coverage. Conclusions: Multiple patient factors and the self-reported factors of fear of complication and financial hardship influenced progression to bariatric surgery in a U.S. metropolitan population. Bariatric surgeons and centers should consider and address these factors when assessing patients.