BACKGROUND Bariatric surgery is in high demand and patients generally undergo an extensive work-up process to maximize the success of surgery, especially in universal healthcare systems. Although valuable, this work-up process can lead to attrition before surgery. Therefore, we aim to assess patient and health system factors associated with attrition after bariatric surgery referral in a universal healthcare system. METHODS This was a population-based study of all patients aged ≥ 18 referred for bariatric surgery in Ontario, Canada from 2009 to 2015. Primary outcome was patients who dropped out of bariatric surgery after referral. Predictors of attrition after referral included patient demographics, clinical, institutional, and socioeconomic variables. Odds ratios and 95% CIs were estimated by multilevel logistic regression models. RESULTS From 17,703 patients that were referred for bariatric surgery, 4122 patients dropped after the initial referral. Male patients, increasing age, and longer wait times for surgery were significantly (P < 0.0001) associated with higher odds of attrition. Additionally, smoker status, immigration status, unemployment, and disability were significant factors (P < 0.0001) predicting attrition. Patients who lived in lowest income quintile neighborhoods, when compared to those from the richest neighborhoods, had significantly higher odds of attrition (P = 0.02). Sleep apnea was associated with lower odds of attrition while diabetes and heart failure both with higher odds of attrition. CONCLUSION Even in a universal healthcare system, there are various factors that could lead to increased odds of attrition before bariatric surgery. Clear disparities exist for certain marginalized populations. Further studies are warranted to ensure equitable utilization of bariatric surgery for all patients.

中文翻译：

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广泛的术前检查的隐性成本：在全民医疗保健系统中进行减肥手术后的损耗预测因子。

背景技术减肥手术的需求很高，并且患者通常经历广泛的检查过程以最大化手术的成功，特别是在全民医疗保健系统中。尽管很有价值，但这种检查过程会导致手术前的磨损。因此，我们旨在评估在全民医疗保健系统中进行减肥手术转诊后与减员相关的患者和健康系统因素。方法这是一项基于人群的研究，研究对象是2009年至2015年在加拿大安大略省接受减肥手术的所有18岁以上≥18岁的患者。主要结局是转诊后退出减肥手术的患者。转诊后的损耗预测因素包括患者的人口统计学，临床，机构和社会经济变量。通过多级逻辑回归模型估计赔率和95％CI。结果在转诊减肥手术的17703例患者中，有4122例初次转诊。男性患者，年龄增长和手术等待时间延长（P <0.0001）与更高的流失几率相关。此外，吸烟者状况，移民状况，失业和残疾是预测员工流失的重要因素（P <0.0001）。与收入最高的社区相比，收入最低的五分之一社区的患者的流失几率明显更高（P = 0.02）。睡眠呼吸暂停与较低的磨损几率相关，而糖尿病和心力衰竭两者与较高的磨损几率相关。结论即使在全民医疗保健系统中，减肥手术前也会有多种因素导致流失几率增加。某些边缘化人群存在明显的差距。必须进行进一步的研究以确保所有患者的减肥手术得到公平的利用。