Multidisciplinary team (MDT) care is central to bariatric surgery, yet follow-up engagement and attrition remain suboptimal. Evidence describing provider-specific engagement across public and private care pathways in Australia is limited.
To compare pre-operative engagement, provider-specific follow-up, attrition and weight outcomes between public and private bariatric surgery pathways in Australia.
This prospective multi-site observational study included adults undergoing bariatric surgery across two public and two private services in New South Wales (2021-2024). Appointment attendance across the perioperative period (12 months pre- to 24 months post-surgery) was analysed. Engagement, attrition and weight outcomes were compared using non-parametric tests, regression analyses and Kaplan–Meier and Cox proportional hazards models.
Results
Of 240 participants, 176 (73%) underwent private and 64 (27%) public surgery. Public patients had higher baseline weight, BMI, multimorbidity and greater socioeconomic disadvantage (all p<0.001). They engaged longer pre-operatively (21.6 vs 2.7 months) and attended more MDT appointments (14 vs 2; both p<0.001), with greater exposure to non-surgical doctors, dietitians, nurses, psychologists, and exercise professionals. Post-operatively, public patients attended more appointments (12 vs 7; p<0.001) and remain engaged longer (18.2 vs 14.5 months). Attrition occurred later in public patients but was similar by 24 months. Weight loss outcomes were comparable beyond 6 months. Surgical setting (B=4.30, p<0.001) and anticipated support need (B=2.17, p=0.038) were independently associated with post-operative attendance.
Continuity of care is driven by service model design and patient-perceived need rather than follow-up volume alone, supporting more individualised, patient-centred models of care.