TY - JOUR
T1 - Restriction of range effects in post–metabolic and bariatric surgery outcomes research
T2 - considerations for clinical decision making
AU - Schreyer, Colleen C.
AU - Salwen-Deremer, Jessica K.
AU - Montanari, Amanda
AU - Coughlin, Janelle W.
N1 - Publisher Copyright:
© 2021 American Society for Bariatric Surgery
PY - 2022/3
Y1 - 2022/3
N2 - Background: Preoperative psychopathology does not consistently predict postoperative outcomes in patients who undergo metabolic and bariatric surgery (MBS). Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect given the limited range of scores on measures of psychopathology included in postoperative analyses, thereby decreasing the power to detect clinically significant differences between groups. Objectives: Our objective was to compare rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SCs, n = 286) and nonsurgical completers (NSCs, n = 125). Setting: Academic medical center, United States. Methods: Participants (n = 411) were a racially diverse sample of MBS candidates who completed a preoperative psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology. Results: Compared with SCs, NSCs had larger scale score variance on measures of psychopathology and were more likely to be Black; to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing; and to use tobacco. Conclusion: Results support the presence of a restriction-of-range effect but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation and may warrant caution when using the current literature to inform clinical decision making for this group. Findings also suggest a need for interventions that will better engage Black patients.
AB - Background: Preoperative psychopathology does not consistently predict postoperative outcomes in patients who undergo metabolic and bariatric surgery (MBS). Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect given the limited range of scores on measures of psychopathology included in postoperative analyses, thereby decreasing the power to detect clinically significant differences between groups. Objectives: Our objective was to compare rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SCs, n = 286) and nonsurgical completers (NSCs, n = 125). Setting: Academic medical center, United States. Methods: Participants (n = 411) were a racially diverse sample of MBS candidates who completed a preoperative psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology. Results: Compared with SCs, NSCs had larger scale score variance on measures of psychopathology and were more likely to be Black; to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing; and to use tobacco. Conclusion: Results support the presence of a restriction-of-range effect but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation and may warrant caution when using the current literature to inform clinical decision making for this group. Findings also suggest a need for interventions that will better engage Black patients.
KW - Binge eating
KW - Depression
KW - Metabolic and bariatric surgery
KW - Pain catastrophizing
KW - Preoperative psychosocial evaluation
KW - Restriction-of-range effect
KW - Tobacco use
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UR - http://www.scopus.com/inward/citedby.url?scp=85121925425&partnerID=8YFLogxK
U2 - 10.1016/j.soard.2021.11.022
DO - 10.1016/j.soard.2021.11.022
M3 - Article
C2 - 34973926
AN - SCOPUS:85121925425
SN - 1550-7289
VL - 18
SP - 425
EP - 432
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 3
ER -