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Factors Associated with Preoperative Attrition from a Large, Racially and Ethnically Representative Bariatric Program
Safraz A Hamid1,2, Samuel D Butensky3, Elena Graetz3,4
1Yale University School of Medicine, New Haven, CT, United States. safraz.hamid@yale.edu.
Obesity Surgery
|April 28, 2025
Summary
Preoperative attrition from metabolic and bariatric surgery (MBS) programs is higher in patients with multiple obesity-related diseases and Medicare insurance. Hispanic ethnicity was linked to lower attrition rates in this diverse patient group.
Area of Science:
- Obesity Medicine
- Surgical Outcomes Research
- Health Disparities
Background:
- Preoperative attrition from metabolic and bariatric surgery (MBS) programs affects patient access to obesity treatment.
- Previous studies on attrition factors were limited by small, non-diverse samples.
- This study analyzed a large, racially and ethnically representative cohort to identify attrition predictors.
Purpose of the Study:
- To identify individual and regional factors associated with preoperative attrition from MBS programs.
- To examine these factors in a large, diverse patient population representative of the US.
- To inform strategies for reducing patient dropout before bariatric surgery.
Main Methods:
- Retrospective review of electronic health records from an urban academic health system (2021-2024).
- Defined preoperative attrition as failure to complete surgery within the study period.
- Used multivariable logistic regression to analyze individual and regional factors, controlling for confounders.
Main Results:
- Of 3043 patients, 28.0% were Black and 31.1% were Hispanic.
- Patients experiencing attrition were older, had more obesity-related diseases, and were more likely to have Medicare insurance.
- Increased odds of attrition were associated with >3 obesity-related diseases (aOR 1.53) and Medicare insurance (aOR 1.94); Hispanic ethnicity showed decreased odds (aOR 0.80).
Conclusions:
- More than three obesity-related diseases and Medicare insurance increase preoperative attrition risk from MBS programs.
- Hispanic ethnicity is associated with a lower risk of attrition in this population.
- Further research is needed to understand attrition causes and develop targeted interventions.
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