Refusals, denials, and patient choice: reasons prospective patients do not undergo bariatric surgery

Background: Many prospective laparoscopic gastric bypass (LGB) surgery patients ultimately do not undergo the procedure. We analyzed the reasons patients did not undergo LGB surgery. Methods: All prospective LGB patients at our institution are required to attend an informational seminar. Our multidisciplinary team then evaluates each patient's suitability for surgery. The medical records of all patients evaluated at our institution from 2001 through 2005 were retrospectively reviewed for age, body mass index, gender, co-morbidities, initial evaluation date, and, if applicable, the reasons for not undergoing surgery. The Mantel-Haenszel test was used to test for trends over time. Results: Of the 1054 patients evaluated, 515 (48.8%) underwent LGB at our institution. The percentage of women did not differ significantly between the LGB and non-LGB groups (82.3% and 78.5%, respectively; P = .116), nor was the difference in mean body mass index significant (48 kg/m² versus 49 kg/m²; P = .074). From 2001 to 2005, the percentage of prospective patients not undergoing LGB increased from 36.6% to 53.7% (P = .001). The percentage of patients not undergoing LGB because of insurance denials or unattainable coverage prerequisites increased from 9.9% in 2001 to 19.9% in 2005 (P = .012). Conclusion: The most common reasons patients did not undergo LGB surgery were insurance denial and unattainable coverage prerequisites. Also, the percentage of prospective LGB patients who did not undergo surgery because of denial or unattainable coverage prerequisites increased over time.