Impact of a structured, multidisciplinary, cross-sectoral program following metabolic-bariatric surgery on obesity-related health status and quality of life: a prospective, non-randomized cohort study

Background: Metabolic and bariatric surgery (MBS) improves the health and quality of life of patients with severe obesity. Interdisciplinary, structured postoperative follow-ups are recommended. Evidence of structured, close-to-home, standardized, non–center-based follow-up programs is limited. Methods: This multicenter, prospective, non-randomized study examined the effects of a non–center-based structured, close-to-home, cross-sectoral, 18-month follow-up program that included trained outpatient physicians, electronic health records, an app, and bariatric case managers. The early intervention group (IG1) started immediately, and the late intervention group (IG2) started 18 months after surgery and were compared to two control groups (CGs) receiving usual center-based follow-ups. The primary endpoint was general health [measured by the modified composite King’s Score (KS)], and secondary endpoints included various quality-of-life measures. The endpoint assessment was conducted 18 months (IG1 vs CG1) and 36 months (IG2 vs CG2) after MBS. Results: MBS substantially reduced body weight and improved comorbidities in all groups. After 18 months, the health status of IG1 ( n = 72) was significantly better than that of CG1 ( n = 180) [KS: 5.79 (95% confidence interval 4.70–6.89) vs 7.22 (6.33–8.10); P = 0.030], while IG2 ( n = 128) and CG2 ( n = 168) did not differ [KS: 7.80 (6.62–8.98) vs KS: 8.03 (6.96–9.11)]. The quality of life of IG1 was also better than that of CG1 (EQ-5D-5L Index: 0.93 vs 0.89, P < 0.05; Short Form-36 Physical Component Score (SF-36 PCS): 53.16 vs 50.32, P < 0.05; Bariatric Quality of Life Index (BQL): 4.20 vs 3.92, P < 0.01), and symptoms of anxiety were reduced [Generalized Anxiety Disorder 7 (GAD-7): 10.32 vs 11.47, P < 0.05]. Conclusions: A qualified non-center-based follow-up program after MBS seems superior in the short term and not inferior in the mid-term to the usual center-based care. Therefore, structured postoperative outpatient care could become a viable option to improve patient care and relieve the workload on specialized obesity centers.