Page 38 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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Chapter 2
Compliance
Eleven studies evaluated the effect of compliance to follow-up on weight loss 20-30. Compliance was calculated using attendance in postoperative appointments 20,23-27,30, postoperative support group meetings 22,28,29 or preoperative appointments 21 (Table 1). Study population ranged from 60-274 patients, mean preoperative BMI ranged from 44.7 kg/m2 to 54.5 kg/m2 and mean follow-up ranged from 1 to 5.8 years. In seven studies compliance was associated with significantly more weight loss and/or successful weight loss 20,22,23,25-27,29.
Data of eight studies with a combined total of 13 follow-up moments and 1,447 pa- tients were included in the meta-analysis (Table 2) 20-27. Mean pre-operative BMI of the compliant group was 51.8 kg/m2 (±2.9) versus 48.8 kg/m2 (±2.5) in the non-compliant group. Follow-up ranged from 6 months to 5.8 years. Compliant patients had a signifi- cantly higher EWL than non-compliant patients; effect size 7.6%, p<0.001 (Figure 2). Subsequently the effect of compliance was assessed for different follow-up moments. Three studies reported on weight loss 6 months after surgery, a total of 253 patients were included; mean EWL was significantly higher in the compliant group when com- pared to the non-compliant group, respectively 52.6% and 48.5% (p=0.006) 20,22,24. Six studies including 668 patients reported on 12 month weight loss; compliant patients had an EWL of 64.8% versus 58.5% for non-compliant patients (p=0.038) 20-23,25,26. Four studies with a total of 448 patients reported weight loss more than 24 months af- ter surgery 20,23,27. Weight loss was significantly higher in compliant patients compared to the non-complaint patients, 70.3% versus 57.3% (p<0.001).
 Table 2:
Meta-analysis on effect of compliance on weight loss in RYGB patients
Author, yr.
Compher, 2012
Compher, 2012
Compher, 2012
El Chaar, 2011
Song, 2008
Song, 2008
Gould, 2007
Gould, 2007
Gould, 2007
Shen, 2004
Harper, 2007
Hatoum, 2008
Robinson, 2014
Overall effect
95%CI
5.01, 8.31 15.27, 18.57 11.19, 14.49 -0.57, 2.37 2.49, 5.71 6.79, 10.01 3.36, 6.64 11.36, 14.64 8.37, 11.63 -0.15, 3.15 9.36, 12.64 -5.70, -2.60 10.52, 13.82 4.29, 10.83
    FU
   Compliant patients
 Non-compliant patients
   ES
    BMI
 EWL
   N
  BMI
 EWL
   N
   6M
  54.50
 46.40
   32
  49.20
 45.30
   28
  6.66
   12M
  54.50
 68.50
   32
  49.20
 55.50
   28
  16.92
   24M
  54.50
 70.70
   32
  49.20
 68.50
   28
  12.84
   12M
  45.30
 61.70
   138
  41.20
 60.80
   39
  0.90
   6M
  52.78
 45.40
   28
  49.66
 41.30
   50
  4.10
   12M
  52.78
 55.50
   28
  49.66
 47.10
   50
  8.40
   12M
  51.00
 70.00
   34
  51.00
 65.00
   41
  5.00
   36M
  51.00
 74.00
   34
  51.00
 61.00
   41
  13.00
   36M
  51.00
 74.00
   34
  50.00
 64.00
   51
  10.00
   6M
  48.70
 67.60
   62
  47.00
 66.10
   53
  1.50
   12M
  48.00
 76.00
   42
  49.00
 65.00
   57
  11.00
   12M
  52.31
 63.56
   183
  51.06
 67.71
   74
  -4.15
   5.8Y
   47.61
  67.78
    104
   47.43
  55.51
    124
   12.17
     51.08
 64.70
   783
  48.82
 58.68
   664
  7.56
                                yr. = year of publication; FU: follow-up in months (M) or years (Y); BMI: Body Mass Index; EWL: percentage excess weight loss; N =
number of patients; ES: effect size; CI: confidence interval
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