Factors affecting the referral of primary health care doctors toward bariatric surgery in morbid obesity

Peer review under responsibility of Alexandria University Faculty of Medicine

Available online 8 June 2011

Figures & data

Table 1 Characters of participating doctors and their work features.

Characteristics	Referral status				Significance
	Yes (n = 92)		No (n = 167)
	No.	%	No.	%
Age (year)
<40	44	47.8	69	41.3	χ^2 = 1.02
⩾40	48	52.2	98	58.7	P = 0.31
Gender
Males	36	39.1	91	54.5	χ^2 = 5.60
Females	56	60.9	76	45.5	P = 0.02
Marital status
Married	84	91.3	151	90.4	χ^2 = 0.06
Unmarried	8	8.7	16	9.6	P = 0.81
Experience (year)
<5	9	9.8	17	10.2	χ^2 = 0.54
5–10	17	18.5	25	15.0	P = 0.76
>10	66	71.7	125	74.9
Specialty
GP	52	56.5	127	76.0	χ^2 = 10.60
FP	40	43.5	40	24.0	P = 0.001
BMI
Normal	27	29.3	35	21.0	χ^2 = 2.97
Over weight	43	46.7	95	56.9	P = 0.23
Obese	22	23.9	37	22.2

Table 2 Effect of physicians’ knowledge on referral for bariatric surgery.

Statement	Referral status				Significance
	Yes (n = 92)		No (n = 167)
	No.	%	No.	%
Definition of morbid obesity that requires surgery in a patient without co-morbidities
Correct	75	81.5	116	69.5	χ^2 = 4.46
Wrong	17	18.5	51	30.5	P = 0.04
Definition of morbid obesity that requires surgery in a patient with co-morbidities
Correct	61	66.3	86	51.5	χ^2 = 5.30
Wrong	31	33.7	81	48.5	P = 0.02
Definition of bariatric surgery
Correct	85	92.4	145	86.8	χ^2 = 1.85
Wrong	7	7.6	22	13.2	P = 0.17
Describing the procedure of vertical bandage gastroplasty
Correct	26	28.3	45	26.9	χ^2 = 0.05
Wrong	66	71.7	122	73.1	P = 0.82
Information about liposuction operation
Correct	44	47.8	78	46.7	χ^2 = 0.03
Wrong	48	52.3	89	53.3	P = 0.86
Bariatric surgery safety in adolescents
Correct	4	4.3	6	3.6	P = 0.75^*
Wrong	88	95.7	159	96.4
Likelihood of postoperative wound complication association with increasing BMI
Correct	61	66.3	100	59.9	χ^2 = 1.04
Wrong	31	33.7	67	40.1	P = 0 .31
The average percentage of the excess weight that is lost in 5 years after bariatric surgery
Correct	24	26.1	34	20.4	χ^2 = 1.120
Wrong	68	73.9	133	79.6	P = 0.290
Dumping syndrome
Correct	44	47.8	58	34.7	χ^2 = 4.261
Wrong	48	52.2	109	65.3	P = 0.039
The risk of early death after bariatric surgery
Correct	3	3.3	4	2.4	P = 0.70^*
Wrong	89	96.7	163	97.6

* Fisher’s exact test.

Table 3 Factors associated with non referral for bariatric surgery, results of multiple logistic regression analysis.

Factors	OR (95% CI)
Gender
Males (R)	1
Females	0.5 (0.3–0.9)
Specialty
GP (R)	1
FP	0.5 (0.3–0.8)
BMI categories
Normal weight (R)	1
Over weight	1.6 (1.2–3.3)
Obese	1.2 (1.1–2.8)
Definition of morbid obesity that requires surgery in a patient without co-morbidities
Correct (R)	1
Wrong	1.4 (1.1–2.9)
Definition of morbid obesity that requires surgery in a patient with co-morbidities
Correct(R)	1
Wrong	1.8 (1.2–3.6)
Definition of bariatric surgery
Correct (R)	1
Wrong	1.3 (1.2–3.5)
The average percentage of the excess weight that is lost in 5 years after bariatric surgery
Correct (R)	1
Wrong	1.4 (1.2–2.4)
Total knowledge score
High (R)	1
Low	1.5 (1.1–3.9)