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Mandatory Waiting Period

Jonathin
on 12/2/10 10:10 pm - Ottawa, Canada
 
Just thought I'd share these. Because in another thread, there seems to be a misconception about "mandatory" wait times for surgery. There were multiple studies done on mandatory 6 month waiting periods that some insurers impose in the States.



http://latimesblogs.latimes.com/booster_shots/2010/06/obesit y-weightloss-surgery-insurance.html

"A study presented Saturday at the annual meeting of the American Society for Metabolic & Bariatric Surgery suggests that the waiting period is ineffective. Researchers followed 440 people who had either laparoscopic gastric bypass or laparoscopic adjustable gastric banding. Of these, 116 people were required by their health insurance plan to wait six months. The study showed there was no significant difference between the two groups in weight loss prior to surgery or one year after surgery."




Jonathin
on 12/2/10 10:11 pm, edited 12/2/10 10:13 pm - Ottawa, Canada
 

These are lovingly stolen from the lovely DS Facts (thanks!)  :


http://www.dsfacts.com/Required-Preop-Weight-Loss.html

Required Preop Weight Loss

Studies demonstrating that required preop weight loss or wait time for surgery is not a predictor of postop bariatric surgery weight loss success.


Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Harnisch et al. May 2008
PubMed Abstract 

BACKGROUND: Success with preoperative weight loss (PWL) is often mandated by the bariatric team to assess patient compliance and has been suggested to correlate with improved postoperative weight loss outcomes.

METHODS: We performed a retrospective analysis of 1629 consecutive patients undergoing laparoscopic Roux-en-Y gastric bypass at Duke University Medical Center. Patients with a preoperative weight gain (PWG) or loss of > or =10 lb were compared. Patients with <12 months of follow-up were excluded.

RESULTS: We found no difference between the 2 groups (PWG, n = 115, PWL, n = 88) with regard to age, gender, race, preoperative body mass index, presence of co-morbidities, or interval between the initial program-entry weight and surgery (149 versus 141 d). No difference was found in the percentage of excess weight loss (EWL) at 12 months, when calculated using the patient's immediate preoperative weight (PWG group, 63.5% EWL versus PWL group, 63.9% EWL, P = NS). If the %EWL was calculated using the initial program-entry weight, the PWL did confer a transient postoperative weight loss advantage; however, this did not persist past 24 months postoperatively. At both 12 and 24 months, the resolution rates of diabetes (82% versus 83% at 2 yr; P = NS), hypertension (48% versus 42% at 2 yr, P = NS), and continuous positive airway pressure discontinuation (87% versus 87% at 1 yr, P = NS) were equivalent. No differences in perioperative complications or conversion rates were detected. The operative time was slightly longer for the PWG group (119.7 versus 104.9 min, P = .02).

CONCLUSION: The results of our study have shown that weight loss before laparoscopic Roux-en-Y gastric bypass is not mandatory and might deter patients from considering weight loss surgery. Laparoscopic Roux-en-Y gastric bypass can be performed safely with equivalent co-morbidity resolution and %EWL regardless of PWG or PWL.
 

Does preoperative weight loss predict success following surgery for morbid obesity?
Mrad et al. May 2008
PubMed Abstract 

BACKGROUND: We analyzed preoperative weight loss as a predictor of postoperative success in patients after bariatric surgery.

METHODS: Data were obtained from a retrospective chart review of 562 patients in a multidisciplinary obesity clinic.

RESULTS: One hundred forty-six patients met the inclusion criteria (23 men and 123 women). The mean age was 39.5 years, and the mean body mass index (BMI) was 52.6 kg/m(2). Comorbid disease includes diabetes (15.7%), hypertension (30.8%), mental illness (38.4%), and musculoskeletal disease (56.8%). Procedures performed were 16 vertical band gastroplasties, 43 open gastric bypasses, 52 laparoscopic gastric bypasses, and 35 laparoscopic adjustable gastric bands. Preoperative weight change was as follows: 31 patients gained weight (21.2%), 56 patients lost weight (38.3%), and 59 patients maintained their weight (40.4%). Postoperative weight loss was not influenced by preoperative weight change among women. However, men who gained weight preoperatively had significantly worse outcomes.

CONCLUSIONS: Patients may achieve satisfactory early postoperative outcomes despite inconsistent or marginal preoperative weight change.
 

Evaluating preoperative weight loss, binge eating disorder, and sexual abuse history on Roux-en-Y gastric bypass outcome.
Fujioka et al. Mar 2008
PubMed Abstract 

BACKGROUND: Roux-en-Y gastric bypass patients often undergo preoperative dieting and psychological assessment before surgery. We examined preoperative weight loss, binge eating disorder (BED), and sexual abuse history and the interactions of these predictors to determine whether a cautionary approach to Roux-en-Y gastric bypass is warranted.

METHODS: Consecutive subjects undergoing Roux-en-Y gastric bypass at our institution from January 1997 to December 2002 were reviewed. The postoperative excess weight loss (EWL) at 1, 3, 6, 12, 18, and 24 months and the perioperative complications were measured. EWL was compared at 12 and 24 months postoperatively in the categories of the presence/absence of preoperative weight loss, BED, and sexual abuse history. The perioperative complications were examined in the preoperative weight change groups.

RESULTS: Of 154 patients, 121 were included. No significant difference in EWL or perioperative complications was observed between those who lost or gained weight preoperatively. Of the 121 patients, 32% and 17% reported a history of BED and sexual abuse, respectively. No statistically significant difference was observed in the EWL between those with and without BED at 12 and 24 months postoperatively. The EWL in those with and without a sexual abuse history at 12 and 24 months was 57.67% and 66.32% (P <.05) and 64.40% and 70.97% (P = NS). No statistically significant interaction between EWL and sexual abuse*BED/sexual abuse*preoperative weight loss was observed.

CONCLUSION: Only sexual abuse history at postoperative month 12 had a negative effect on EWL. Otherwise, physicians can expect to see successful EWL in these subjects up to 24 months postoperatively. We recommend that additional investigation be done of those with BED and a sexual abuse history.


Patients who are delayed from undergoing bariatric surgery do not have improved weight loss.
Madan et al. Mar 2008
PubMed Abstract 

BACKGROUND: Many patients have a prolonged wait time between initial surgeon visit and actual surgery day. Whereas there are various reasons for this, few have examined if patient wait time for bariatric surgery has any affect on weight loss. This investigation studies the hypothesis that patients who wait longer for bariatric surgery do not have improved weight loss over those with shorter wait times.

METHODS: All patients in a private academic practice who underwent laparoscopic gastric bypass over a 6-month period were included in this study. The time from initial office visit to actual surgery date was calculated to be wait time (WT). Reasons for short or long WT were not investigated. The relationship between WT and percentage excess body weight loss (%EBWL) was examined. In addition, patients whose WT was greater than 6 months (WT > 6) were compared to those less than 6 months (WT < 6). Pearson's correlation coefficients and two-tailed Mann-Whitney tests were used as appropriate.

RESULTS: There were 104 patients with 99 patients who had a >1 year follow-up. WT did not correlate with %EBWL (r = 0.09, p = 0.37). There was no difference in %EBWL in the WT > 6 group versus the WT < 6 group (73 vs. 70%; p = NS). Patients who had <50% EBWL waited an average of 281 versus 254 days for those who have >50% EBWL (p = NS).

CONCLUSIONS: Patients who wait longer before having bariatric surgery do not show improved weight loss. Weight loss success was not related to wait time. These results suggest that prolonged mandatory weight times are not an effective method for improving bariatric surgery weight loss outcomes. Mandatory delays for bariatric surgery should not be required, as they have no scientific merit.
Jonathin
on 12/2/10 10:23 pm, edited 12/2/10 10:26 pm - Ottawa, Canada
charm64
on 12/3/10 6:23 am - Cambridge, Canada
Very interesting! Thanks for posting

Char

Char
Dr. Reed
VSG May 24/2011

Terry45
on 12/3/10 7:27 am
RNY on 09/03/09 with

Very interesting post..how are you doing..will you and your daughter be coming to the Christmas PArty? I hope because the group has a gift for your daughter!

Let us know how your journey is going...any word yet on surgery date etc?

Cheers

Terry45

 

               
Jonathin
on 12/3/10 8:17 am - Ottawa, Canada
 
No word. Ottawa's on February, so hopefully I'll hear something in February.  Nothing from the other clinics. Tried calling OHIP to request being transferred, they haven't called back. So.. not much more I can do.

We'll be there, hopefully!

sam1am
on 12/3/10 9:40 am
I can't see how waiting (provided people have done their researching in full) could improve anything.  I just had more food funerals the longer I waited, cause waiting blows!

 Sandy                                           
                
"The best way to cheer yourself up is to try to cheer somebody  else up"                     
                          
      Mark Twain                                                       LW-Apple-Gold-Small.jpg image by PlicketyCatAnimation One      
   

                               

jan135
on 12/3/10 10:30 am
 I don't understand the rational behind wait times either.  What are they waiting for? Patients to have heart attacks, strokes......  My dr knew I'd tried every diet known to man before I made my decision to have WLS.  I think that's true of most of us, we didn't wake up fat one morning and say tomorrow I want WLS.
Is it elective surgery?  I guess it is, but then if you say that so are most surgeries being done unless you're in critical condition and about to die.
  
    
                                                                                          
               
AllieInOntario
on 12/3/10 10:52 am
DS on 06/20/11 with
Jan and Jonathan, there is no rational for wait periods, other than to hope you just "get lost" and quit bothering them (OHIP or US insurance) companies with your need for health care.

Some WLS patients have to see a social worker.  Now you tell me... WTF does a social worker have to do with knowing the first thing about weight lost surgery???? Esp since you've already gone through nutritionists, nurse practioners, this eval, that eval.   It's just a big giant set of hoops they want you to go through in order to weed out the amount of people who actually stay in the queue.  Sad.

You see this kind of crap no matter if it's applying for workman's comp (read the papers the stories are out there), making a legit claim for injury via insurance (had a friend hit by a drunk driver - 3 years and 2 lawyers to fight for that mess), US insurance carriers and now OHIP has learned it's lessons well from other "deny and force them appeal" type of coverages.
jan135
on 12/3/10 11:46 am
 I was thinking the same thing that OHIP must be taking lessons from the US insurance companies regarding pt treatment.   Make them wait so long they'll die or become too sick to tolerate surgery.  And before anyone says anything that is a sad reality in the US.  
  
    
                                                                                          
               
Karen M.
on 12/3/10 11:52 am - Mississauga, Canada
You're right, it is the reality there and terribly sad.  Not to mention the huge amounts of money that people are forced to borrow so that they can have surgery.  It's pathetic.

 

Karen

Ontario Recipes Forum - http://www.obesityhelp.com/group/ontario_recipes/

Jonathin
on 12/3/10 3:09 pm - Ottawa, Canada

Oh I totally agree, Allie. It's totally to weed out people and make them give up and resort to self pay. Like has been said, it's all about the money, and not about the care. They wanted to reduce the number of people they had to pay for.. and what better excuse than a long drawn-out ordeal?

But.. I didn't post about the process as much as I posted these because one poster in another thread was talking about how it's required, to triage patients. They aren't really treating it as a triage. You just take your number and wait in line. Like cattle waiting to be branded and hoping you make it to the green field beyond.

But I realized it's a moot point anyway, because I found out the poster in question has me blocked.  Oh well, it could be a million and a half reasons how I've offended her. lol


AllieInOntario
on 12/3/10 5:38 pm
DS on 06/20/11 with
I agree Jonathan, ....  IMO triage by device implies some form of urgency.   The OHIP system is anything but.  Triage would have you meeting a "team" within a very short period of time and if one went to bat for your surgery...  the team would follow suit.  Here, it's about OHIP giving each step in the ladder their own little thief-dom and now that they each have their paws in the OHIP money pie, I somehow doubt that getting rid hoops of needless consultations is going to happen any times soon.  Sad.


supergirl3
on 12/3/10 5:58 pm - Canada
I think these wait times stem from a long-held  societal belief about obesity being a moral failure and therefore, obese people should be treated as second-class citizens. 

This is a great article, thanks for posting.

SUPERGIRL
Start weight - 287
Lowest - 123
Current - 130's
Height 5'7"