Bariatric surgery results in substantial medical and economic benefits; however, independent studies typically report high patient preoperative attrition rates. Studies have identified individual characteristics and sociodemographic variables of those who complete the surgery compared to those who do not.
The databases Scopus, CINAHL, PsycINFO, Web of Science, and MEDLINE will be searched for the retrospective, perspective, and cross-sectional observational studies that have identified any sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who are enrolled in a bariatric surgery programme.
English-language articles published between 1997 to 2020, inclusive of adults 18 years or older, will be included in the review. This protocol has been registered in PROSPERO, registration number; CRD42017068557.
Presently, there are studies and reviews investigating population-based utilization and access to bariatric surgery; however, there is a need to review the reasons behind preoperative bariatric surgery patient attrition once selected for bariatric surgery.
Bariatric surgery programmes
The results of the review will highlight potential systematic disparities in patient attrition, where gaps in knowledge remain for further investigation and suggest areas where countermeasures may be focussed for decreasing attrition rates. These results suggest the importance of establishing healthy lifestyle behaviors at the pre-surgical stage.
To reduce complications and improve weight loss, many bariatric programs require patients to achieve a preoperative weight loss of approximately 10% of excess body weight above a BMI of 25 to increase fitness and mobility, to quit smoking and show improved glycemic control through diet.
There are limited understandings of which patients are specifically more likely to adhere to the preoperative requirements, although one review found that patients who received surgery were more likely to be white, female, and have private medical insurance.
This suggested that sociodemographic factors may be a contributing factor to preoperative program retention. In summary, it is important that barriers to preoperative care are synthesized so that providers can better support their patients through the preoperative stage and achieve best possible post-surgical outcomes.
This protocol describes a systematic review that aims to identify the sociodemographic, medical, cultural, psychological, and patient-led factors related to preoperative attrition in patients who were enrolled in bariatric surgery programmes.
The primary outcomes of interest are any sociodemographic, medical, cultural, psychological, patient-led factors affecting preoperative attrition. Additionally, any other factors that arise from the literature can be included in these categories if they are deemed to contribute to patient attrition.
The sociodemographic characteristics of interest are those affecting population-based bariatric surgery access also identified by Bhogal et al. Including place of residence, race/ethnicity, occupation, gender/sex, religion, education, language, socioeconomic status, and social capital.