Table 3.

Factors considered as determinants in bariatric surgery decisions by a group of health care system stakeholders including patients, providers, and bariatric surgeons in the ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study.

Factor	Preferred operation	Rationale	Available in electronic medical record
Year of surgery	Depends on year	Secular trends in surgery were apparent with RYGBa preferred in years before 2011 and VSGb preferred after 2011.	Yes
Preparation course instructor	Depends on instructor	Preparation course instructors have operation preferences and can communicate these to the patients and influence their choices.	Yes
Bariatric surgeon	Depends on surgeon	Surgeons have operation preferences as evidenced by frequency of type of operation over time.	Yes
Media consumption	Depends on source	Patients may be influenced to choose an operation based on electronic and other media consumption.	No
Patient race/ethnicity	VSG	More non-Hispanic black patients are having VSG compared with RYGB possibly because it is less surgery, and they will not lose too much weight.	Yes
History of cirrhosis and abdominal surgeries	VSG	Some bariatric surgeons believed that RYGB was inappropriate for patients with a history of cirrhosis and/or abdominal surgeries.	Yes
NSAIDc and aspirin use	VSG	Some bariatric surgeons believed that patients requiring anti-inflammatories (NSAIDs, aspirin, and steroids) were high risk for surgery regardless of operation type; however, the highest risk was for RYGB.	Yes
BMI >50 kg/m2	VSG	Some bariatric surgeons believed that much heavier patients had higher complication rates and that patients could be offered VSG to induce weight loss for a possible later, safer RYGB operation.	Yes
Medication-treated mental health	VSG	Some bariatric surgeons believed that patients requiring medication for mental health conditions may not do well after RYGB because of changes in absorption/metabolism after surgery.	Yes
Poor portion control	VSG	Some bariatric surgeons believed that if patients were severely obese mostly because of portion control, VSG would be the most conservative and successful option.	No
Complications	VSG	Most bariatric surgeons felt that VSG resulted in fewer complications than RYGB and should be the preferred operation to start, unless clearly contraindicated by GERDd or gastrointestinal conditions.	Yes
Sweet eating/craving	RYGB	Some bariatric surgeons believed that the adverse consequence of dumping syndrome with RYGB following sweet-eating binges was a good deterrent for these patients helping them be more successful.	No
Type 2 diabetes mellitus, hiatal hernia, and GERD	RYGB	Some bariatric surgeons believed that RYGB was better for diabetes remission, and hiatal hernia and GERD would complicate VSG.	Yes

^aRYGB: Roux-en-Y gastric bypass.

^bVSG: vertical sleeve gastrectomy.

^cNSIAD: nonsteroidal anti-inflammatory drug.

^dGERD: gastroesophageal reflux disease.