Pre-operative weight loss targets remain in widespread use in public bariatric programmes, despite limited evidence to support their effect on patient outcomes. Furthermore, recently published data demonstrated a disproportionately higher attrition rate at Auckland DHB for Māori and Pacific patients (39% NZ Europeans, 50% Māori, 73% Pacific patients). In 2017, mandatory weight loss targets were eliminated from the pre-operative criteria at ADHB. Our primary aim was to determine the effect of removing mandatory weight loss targets on attrition rates and weight loss outcomes.
We performed a retrospective analysis of 200 consecutive patients who underwent bariatric surgery from January 2016 to May 2018 at Auckland City Hospital; 100 patients from each of the old and new programme. All patients completed three weeks of pre-operative Optifast VLCD prior to surgery. Patients were allocated to either sleeve or bypass at the discretion of the surgeon, and followed for at least 1 year post-surgery.
Across the 200 patients, the mean age was 46.8 and 65.5% were female. Mean percentage excess weight loss at 12 months follow-up was 67.9% for the old programme and 68.7% for the new programme (p=0.76). Weight loss was greater for gastric bypass compared to sleeve in both programmes (p<0.0001). Weight loss was greater at the time of booking in the old programme (p=0.0005), but total weight loss at the time of surgery and weight loss on Optifast were similar between the two groups. The difference in attrition rates between ethnicities improved after the introduction of the new programme (37.6% NZ Europeans, 52.2% Māori, 58.7% Pacific patients).
Although a discrepancy remained between ethnic groups, attrition rates improved for Pacific patients. The programmes were equivalent for weight loss outcomes. Thus, the removal of mandatory weight loss targets improves equity of access without compromising the efficacy of bariatric surgery.