Background

Operative selection in metabolic surgery (MS) is a complex, collaborative process between patient and surgeon, considering factors such as risk, medical comorbidities, cost, as well as desired weight loss and resolution of associated conditions. This study aimed to explore patient preferences for bariatric procedures to assess the impact of body mass index (BMI) and surgeons on operative selection.

Methods

Retrospective review of 609 patient surveys prior to initial surgical visit (2015-Present) was conducted at a single institution. Patient preferences and characteristics, as well as operation preference were examined, including the influence of BMI and operating surgeon at the institution.

Results

Prior to the initial visit, 56% of patients indicated preference towards sleeve gastrectomy (SG), while 18% indicated preference toward Roux-en-Y gastric bypass (RYGB); a small percentage favored alternative procedures or remained undecided. Notably, initial patient preferences aligned with actual procedure, with 72% of SG-desiring patients and 66% of RYGB-desiring patients receiving their preferred operation. Aside from preference, body mass index (BMI) influenced procedure selection, with higher BMI correlating with increased likelihood of undergoing SG and decreased likelihood of undergoing RYGB (x2=34.584, df=16, p=0.0004). Inter-surgeon comparisons demonstrate a clear impact on procedure received when compared to initial patient preference with matches ranging from 28.8-100% for SG and 33-87.8% for RYGB.

Conclusions

Procedure selection remains a complex interplay of patient characteristics and surgeon influence in MS procedure selection, emphasizing the need for personalized decision-making and increased long-term outcome data in the field.