Follow-up lacking in most studies of bariatric surgery: review

Last Updated: 2016-05-27

By Anne Harding

NEW YORK (Reuters Health) - Just 40% of studies in the bariatric surgery literature meet standards for adequate follow-up, according to a new systematic review.

"Bariatric surgery treats a chronic disease, which is obesity, and we need to be better at evaluating our outcomes," Dr. Noah J. Switzer of the University of Alberta Hospital in Edmonton, Canada, the first author of the new study, told Reuters Health.

The McMaster Evidence-based Criteria for High Quality Studies state that prevention or treatment studies must be able to measure a specific outcome at any given follow-up point for at least 80% of randomized patients, Dr. Switzer and his team explain in the May issue of Annals of Surgery.

However, follow-up data is "notoriously bad" for studies of surgical interventions compared with medical interventions, the researcher noted, and bariatric surgery has been specifically criticized for poor follow-up.

In the new study, Dr. Switzer and his colleagues looked at bariatric surgery studies published from 2007 to 2012. The 99 studies reviewed included more than 245,000 patients.

Among the studies reviewed, 17.2% failed to report any follow-up data at all, 42.4% did not report adequate follow-up data, and 40.4% met the McMaster criteria.

An average of 31% of patients were lost to follow-up. Shorter studies and those done in the U.S. tended to have higher-quality follow-up data.

"We know that if you have good patient follow-up in bariatric surgery it leads to better outcomes, more weight loss and decreased weight regain," Dr. Switzer said.

Bariatric-surgery patients are likely to have many other issues that need to be addressed, such as depression and alcohol abuse, as well as food urges, he added.

"We need our dietitians to see them, we need our psychologists to seem them, we need our addiction specialists to see them. If you just treat their disease with bariatric surgery and don't ever see them again, there's always going to be weight gain," Dr. Switzer said.

Comprehensive follow-up, such as the data being collected by Nurses Health Study researchers, is costly, he added. And bariatric surgery patients may also face economic barriers to receiving good follow-up care. "It's partly a funding issue, it's just a product of the actual patients we deal with as well," Dr. Switzer said.

The effectiveness of bariatric surgery for curing obesity, diabetes, hypertension, sleep apnea and other health concerns related to excess weight is now widely recognized, the researcher said. Investigators in the field now "just have to step up our game" in order to improve the quality of research, he added.

SOURCE: http://bit.ly/1P34y5g

Ann Surg 2016.