Predictors of bariatric surgery among an interested population

Abstract

Background: Severely obese patients considering bariatric surgery face a difficult decision given the tradeoff between the benefits and risks of surgery. The objectives of this study was to study the forces driving this decision and improve our understanding of the decision-making process.

Methods: A 64-item survey was developed to assess factors in the decision-making process for bariatric surgery. The survey included the decisional conflict scale, decision self-efficacy scale, EuroQol 5D, and the standard gamble. Patients were recruited from a regularly scheduled bariatric surgery interest group meeting associated with a large, university-based bariatric practice and administered a survey at the conclusion of the interest group. Logistic regression models were used to predict who pursued or still planned to pursue surgery at 12 months.

Results: 200 patients were recruited over an 8-month period. Mean age was 45 years; mean BMI was 48 kg/m(2), and 77% were female. The 12-month follow-up rate was 95%. At 12 months, 33 patients (17.6%) had surgery and 30 (16.0%) still planned to have surgery. There was no association between age, gender, or obesity-associated conditions and surgery or plan to have surgery. Patients having surgery or still planning to have surgery had significantly worse scores for quality of life and better scores for decisional conflict (indicating readiness to make a decision).

Conclusion: The decision to have bariatric surgery is strongly associated with patients' perceptions of their current quality of life. In addition, lower decisional conflict and higher self-efficacy are predictive of surgery. Interestingly, factors that clinicians might consider important, such as gender, age, and the presence of obesity-associated co-morbidities did not influence patients' decisions.

Keywords: Bariatric surgery; Decisions; Quality of life.

Figure 1

Plot of individual decisional conflict scores on the x-axis and decisional self efficacy scores on the y-axis. Lower decisional conflict scores indicate less decisional conflict, and higher self-efficacy scores indicate higher self efficacy. The lines represent the median score for each scale.