Factors Associated with Preoperative Attrition from a Large, Racially and Ethnically Representative Bariatric Program in the USA: A Single-Center Retrospective, Cohort Study

Abstract

Background: Preoperative attrition from metabolic and bariatric surgery (MBS) programs remains a barrier for a subset of patients seeking surgical treatment of obesity. Prior analyses examining factors associated with attrition have been limited by study samples that are small in number and predominantly non-Hispanic, White. We aimed to assess factors associated with preoperative attrition using a large, racially and ethnically representative study sample.

Methods: We reviewed the electronic health record of an urban, academic health system from 2021 to 2024. Our outcome was preoperative attrition, defined as not completing surgery within the study period. We compared individual- and regional-level factors between patients who experienced attrition with those who did not. We accounted for confounding effects using multivariable logistic regression.

Results: Of a total 3043 patients, 28.0% were Black and 31.1% were Hispanic. Compared to patients who completed surgery, those who experienced attrition were older (mean age (SD): 43.9 (12.7) years vs. 41.8 (12.1) years, p < 0.001), were proportionally more likely to have obesity-related diseases (1-3 diseases: 59.3% vs. 55.9%; 3 diseases: 13.1% vs. 9.1%, p < 0.001), and more likely to be insured by Medicare (5.2% vs 2.2%, p < 0.001). Census tract social vulnerability, as measured by the social vulnerability index (SVI), was not associated with attrition (median (IQR) SVI percentile: 0.67 (0.59) vs. 0.59 (0.59), p = 0.071). In adjusted analysis, patients with more than three obesity-related diseases and those insured by Medicare had 53% (aOR 1.53, 95% CI 1.10-2.13) and 94% (aOR 1.94, 95% CI 1.14-3.30) increased odds of experiencing attrition, respectively. Hispanic ethnicity was associated with decreased odds of experiencing attrition (aOR 0.80, 95% CI 0.66-0.97).

Conclusions: Among a large sample of patients racially and ethnically representative of the US population, the presence of more than three obesity-related diseases and Medicare insurance were associated with increased odds of preoperative attrition from an MBS program while Hispanic ethnicity was associated with decreased odds. Future studies should elucidate reasons for attrition and develop strategies to address the factors associated with attrition.

Keywords: Access; Metabolic and bariatric surgery; Preoperative attrition.