The Use of Multidisciplinary Teams to Evaluate Bariatric Surgery Patients: Results from a National Survey in the U.S.A.

Abstract

The degree to which U.S. bariatric surgeons use multidisciplinary methods to evaluate patients is unknown. We conducted a national survey of practising bariatric surgeons, mailed in 3 waves from September-December 2004, to describe and determine predictors of surgeons' approach to the multidisciplinary evaluation of prospective bariatric surgery patients. Multivariate analyses were performed to determine patterns and predictors of multidisciplinary methods. The response rate was 62% (813/1,312). Although 95% of respondents reported using a multidisciplinary team, only 53% had a general physician, nutritionist, and mental health specialist (NIH-recommended team). Just 47% mandated primary care, nutrition, and mental health evaluations (NIH-recommended evaluations). Practice type, size, and location as well as membership in the American Society for Bariatric Surgery did not influence these outcomes. General surgery board certification reduced the odds of having an NIH-recommended team (OR=0.56, 95%CI 0.35-0.92). Practicing bariatric surgery for >8 years decreased the odds of reported multidisciplinary team use (OR=0.29, 95%CI 0.10-0.82) and requiring NIH-recommended evaluations (OR=0.36, 95%CI 0.24-0.53). Medium volume surgeons had increased odds of reporting use of a team (OR=2.96, 95%CI 1.22-7.18) and decreased odds of requiring NIH-recommended evaluations (OR=0.65, 95%CI 0.44-0.92). Inconsistent and unpredictable patterns of multidisciplinary methods were found. Further research should explore the impact of different methods on outcomes. New policies should detail a minimum standard for the multidisciplinary evaluation of bariatric surgery patients. Health professionals across disciplines are needed to assist surgeons in evaluating prospective bariatric surgery patients.