• Sarit Polsky, William T Donahoo, Ella E Lyons, Kristine L Funk, Thomas E Elliott, Rebecca Williams, David Arterburn, Jennifer D Portz, and Elizabeth Bayliss.
• University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, Mail Stop A140, Aurora, CO 80045. E-mail: Sarit.Polsky@ucdenver.edu.
• Am J Manag Care. 2015 Mar 1; 21 (3): 182189182-9.

ObjectivesTo examine the effect of pre- and postoperative care management on weight loss following bariatric surgery.Study DesignWe conducted a retrospective cohort study supplemented by cross-sectional surveys across 9 bariatric surgery centers.MethodsBased on the intensity of patient contact, care management intensity (CMI) was defined as high, moderate, or low for preoperative programs, and high or low for postoperative programs. Multivariable linear regression assessed 1- and 2-year post operative weight loss as a function of CMI.ResultsIn the 9 centers, 4433 individuals underwent Roux-en-Y gastric bypass or adjustable gastric band placement between 2005 and 2009. Two sites had low, 5 had moderate, and 2 had high preoperative CMI; 5 sites had low and 4 had high postoperative CMI. In analyses stratified by procedure and adjusted for multiple covariates including site, we found no statistically significant associations between either preoperative or postoperative CMI and post operative change in body mass index at year 1 or year 2. Results were limited by heterogeneity of care management across sites and an inability to assess adherence to care management programs.ConclusionsProspective investigations that incorporate quantifiable measures of CMI and measure individual adherence to components of care management programs are needed to more accurately determine the effect of care management on weight loss. Additional investigations should examine the effect of CMI on other relevant outcomes, such as nutritional status and quality of life, that may be more directly affected by care management.

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