Long-term follow-up after bariatric surgery in a national cohort

Background: Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. Methods: All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. Results: Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P < 0.001) and calcium (from 14.4 to 7.7 per cent; P < 0.001), but increased for vitamin D (from 33.1 to 34.7 per cent; P < 0.001). The percentage of patients with one or more visits to a surgeon decreased between the first and fifth years, from 87.1 to 29.6 per cent (P < 0.001); similar decreases were observed for visits to a nutritionist/endocrinologist (from 22.8 to 12.4 per cent; P < 0.001) or general practitioner (from 92.6 to 83.4 per cent; P < 0.001). The mean number of visits to a general practitioner was 7.0 and 6.1 in the first and the fifth years respectively. In multivariable analyses, male sex, younger age, absence of type 2 diabetes and poor 1-year follow-up were predictors of poor 5-year follow-up. Conclusion: Despite clear national and international guidelines, long-term follow-up after bariatric surgery is poor, especially for young men with poor early follow-up.