Outcome expectation and risk tolerance in patients seeking bariatric surgery

Abstract

Background: Average long-term outcome after laparoscopic Roux-en-Y gastric bypass is 25% total weight loss. The risk of short-term complications (leakage and bleeding), acute internal herniation, and mortality are 4.0%, 2.5%, and .2%, respectively. There is a paucity of evidence on what patients expect in terms of weight loss and to what extent surgical risks are tolerated.

Objective: To examine the patient's weight loss expectations and acceptance of the morbidity and mortality risk after primary laparoscopic Roux-en-Y gastric bypass.

Setting: Teaching hospital, Amsterdam, the Netherlands.

Methods: Two-hundred patients participated in a standardized survey after completion of an extensive multidisciplinary screening, before surgery. Weight loss expectations, naive assessment, and acceptation of risks of morbidity and mortality were addressed with standard gamble methods.

Results: The 200 participants (156 female, 78%) had a mean age of 45.1 years and a mean body mass index of 42.3 kg/m². Weight loss was overestimated by 151 patients (75.5%), and 79 participants (39.5%) were disappointed with the predicted weight loss. Median accepted risks on short-term complications, acute internal herniation, and mortality were 35.8% (interquartile range, 21.0%-58.0%), 25.1% (interquartile range, 15.9%-50.8%), and 4.5% (interquartile range, 1.0%-10.0%), respectively.

Conclusion: Patients seeking bariatric surgery seem to have unrealistic weight loss objectives and are willing to accept substantial risks to achieve these goals.

Keywords: Bariatric surgery; Outcome expectation; Risk acceptation.