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Patients who attend follow-up have better outcomes
Bariatric patients who stick to a schedule of three-, six- and 12-month follow-up visits with their doctors see greater improvements or remission of their diabetes, high blood pressure and high cholesterol than patients who skip their visits, according to research presented at ObesityWeek 2016. The paper, “The effect of close postoperative follow-up on comorbidity improvement after bariatric surgery,” was presented by researchers from the Brody School of Medicine at East Carolina University in Greenville, NC.
The study assessed the relationship between complete follow-up and improvement or remission of comorbid conditions at 12-months after surgery. The investigators obtained data from the Bariatric Outcomes Longitudinal Database (BOLD) from 2007 to 2012 and reviewed the results of 38,613 patients who had the three follow-up visits (complete follow-up) and compared them to the results of 12,468 patients who only had one or two follow-ups (incomplete follow-up). Improvement and remission of comorbid conditions were compared between the two cohorts. Specifically, changes in diabetes (T2D), hypertension, and dyslipidemia were evaluated at 12-month postoperatively.
After one year, 62.3 percent of patients with complete follow-up saw their type 2 diabetes go into remission, while those who missed a visit or two had a remission rate of 57.5 percent. The rate of improvement in diabetes was also better for those who made all three visits (74.6% vs. 68.9%). The differences between the two groups also held for high blood pressure and lipid abnormalities including high cholesterol.
“This study shows there is great value in seeing patients at routine intervals after surgery in terms of health outcomes,” said Dr Andrea Schwoerer, study co-author, currently at Carolinas Medical Center. “Unfortunately, many patients, reportedly as many as 50 percent, are lost to follow-up and therefore may not benefit as much as they can from weight-loss surgery, no matter how well it was performed.”
Hypertension improved in 63.2 percent of the patients in the complete follow-up group and 58.1 percent in the incomplete follow-up group. The difference in resolution rates in the groups was less, but still statistically significant (46.1% vs. 42%). The trend also held for lipid abnormalities, with these improving for 55 percent of patients completing follow up versus 51.1 percent for those who did not. Remission rates were,42.8% vs. 41.1% respectively, a small, but still statistically significant difference. After adjusting for baseline characteristics, complete postoperative follow-up in the first year after surgery was independently associated with a higher rate of improvement or remission of comorbid conditions.
“We cannot stress enough the importance of follow-up visits and post-operative care,” said Dr Stacy Brethauer, President-elect, ASMBS and bariatric surgeon at the Cleveland Clinic in Ohio, who was not involved in the study. “It could mean the difference between a good and a great result. The most committed patients do best, and we need to find ways to keep all patients engaged for the long-term.”