Original article
Pre–Lap-Band group education in Medicaid population: does it really make a difference?

https://doi.org/10.1016/j.soard.2009.11.021Get rights and content

Abstract

Background

The effect of group education classes before a Lap-Band procedure has not been well defined. We hypothesized that in a Medicaid population, the completion of a standardized 12-week multidisciplinary preoperative program (SMPP) would significantly improve the preoperative and early postoperative weight loss. All procedures were performed at a University-affiliated community hospital from 2006 to 2007.

Methods

A prospectively collected database of 292 patients who underwent Lap-Band placement was retrospectively reviewed. All patients in the study cohort were encouraged to participate in the SMPP, which included medical, psychological, and nutritional interventions. The patients were divided into 2 groups according to their participation in the SMPP program: SMPP compliant and non-SMPP compliant. The postoperative weight loss of these 2 groups was then compared using the general linear models for repeated measures statistical analysis.

Results

No significant difference was found in the mean baseline excess body weight between the 2 groups (74 ± 20 kg in the SMPP-compliant and 76 ± 20 kg in the non–SMPP-compliant participants). The mean baseline body mass index (47 ± 7 versus 48 ± 72 kg/m2 for the SMPP-compliant and non–SMPP-compliant participants) was also similar in the 2 groups. The postoperative follow-up rate was 94.5% at 1 month, 72.3% at 6 months, and 52.7% at 12 months. The excess weight loss was significantly greater in the SMPP compliant group than in the noncompliant group during the observed 12-month follow-up period (P = .04, by general linear models for repeated measures).

Conclusion

In a Medicaid population, implementation of an intensive preoperative SMPP resulted in a significant improvement in the short-term weight loss after Lap-Band placement.

Section snippets

Methods

All patients undergoing LAGB at Mercy Hospital and Medical Center (Chicago, IL) from April 2006 to December 2007 were enrolled and encouraged to attend a comprehensive, multidisciplinary bariatric management program. The patients were instructed that they would be declined surgery if they did not attend the SMPP classes; however, no patient was declined surgery if they were medically fit for the procedure. The patients who were candidates for Lap-Band surgery were recruited after informed

Results

The study enrolled 276 patients who had undergone LAGB at our institution. The average preoperative weight for all subjects was 132 ± 23 kg. The average BMI was 48 ± 7 kg/m2, and the mean EBW was 74 ± 20 kg. The postoperative follow-up rate was 94.5% at 1 month, 72.3% at 6 months, and 52.7% at 12 months. The cohort demographics are listed in Table 2.

The patients were divided into 2 groups according to their participation in the SMPP program, with 222 in the SMPP-compliant group and 54 in the

Discussion

Our data have demonstrated that SMPP-compliant Medicaid patients undergoing LAGB surgery will have greater short-term EWL (≤12 months) than non-SMPP patients. The pattern of EWL achieved by our SMPP compliant group was similar to what has been previously reported for the general population undergoing LAGB [11], [12].

Previously, Jamal et al. [7] found that patients undergoing mandatory preoperative dietary counseling had a signficantly lower %EWL (60% versus 67%; P <.001), a greater BMI (35 kg/m2

Conclusion

In this retrospective review, our Medicaid patients who successfully completed more than one half of the SMPP had significantly improved postoperative weight loss. These 12-month results are comparable to well-known international standards. We believe that these interventions should be routinely offered to Medicaid patients undergoing LAGB to optimize the outcomes.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (17)

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At the time of this research, all (with the exception of Dr. Torquati) were affiliated with Mercy Hospital and Medical Center in Chicago, IL.

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