Predictors of Attrition in Bariatric Aftercare: A Systematic Review of the Literature

Bariatric surgery results in greater weight loss and maintenance than non-surgical interventions in obese patients. Inadequate adherence to aftercare is associated with poor weight loss and maintenance, poorer control of obesity-related comorbidities, and the development of post-operative complications. This study aims to identify factors influencing failure to attend follow-up visits in the adult post-bariatric surgery patients. A systematic review was undertaken to identify factors associated with attrition from bariatric aftercare in adult (18-65 years) obese (BMI > 30) patients. Eight studies published before May 2011 and addressing factors associated with bariatric aftercare attendance were identified. Few consistent findings were evident. Greater pre-surgical weight and greater travel distance to the follow-up centre were more commonly associated with attrition. Conclusions were limited by the very small number of studies, the different types of bariatric surgery studied and the variety of methodologies employed and variables considered. There is a need for research identifying the modifiable attrition risk factors that can be targeted to improve surgical aftercare attendance. This has the potential to facilitate long-term weight loss and maintanence as well as to reduce post-operative complications and costs; thus improving both the effectiveness and the cost-effectiveness of bariatric surgery.