Preoperative weight loss: is waiting longer before bariatric surgery more effective?

Many insurance companies require patients to undergo supervised weight loss programs lasting several months. However, the association between time to surgery (TTS)-the wait time between the initial consultation visit and the immediate preoperative visit-and weight loss is not well documented.

To investigate whether TTS affects pre- or postoperative weight loss or complication rates.

University hospital, United States.

Data from 415 patients undergoing laparoscopic Roux-en-Y gastric bypass (n = 263) or sleeve gastrectomy (n = 152) at a single academic institution between 2014 and 2015 were retrospectively reviewed. TTS was compared with the percentage of total weight lost, change in body mass index, and adverse surgical events.

Participants had an average body mass index of 47.42 kg/m² at the consultation visit and TTS ranged from 7 to 1813 days with an average wait of 209.23 days. There was a statistically significant negative correlation between TTS and preoperative percentage of total weight lost among gastric bypass patients (b = -.005; P = .0492 2-tailed). A similar inverse relationship was identified among sleeve gastrectomy patients. Extended TTS provided no significant long-term benefits in weight loss by 24 months. No significant difference in rates of complications or readmissions was identified.

Longer preoperative wait times do not result in improved weight loss or reduced adverse events. Determination of patient eligibility for bariatric surgery should rest with the health team and delay of treatment should be minimized.