An exploratory study of long-term publicly waitlisted bariatric surgery patients’ quality of life before and 1 year after bariatric surgery, and considerations for healthcare planners

<strong>Background:</strong> Long-term publicly waitlisted bariatric surgery patients typically experience debilitating physical/ psychosocial obesity-related comorbidities that profoundly affect their quality of life.<p></p> <p><strong>Objectives:</strong> We sought to measure quality-of-life impacts in a study population of severely obese patients who had multiyear waitlist times and then underwent bariatric surgery.</p> <p><strong>Methods:</strong> Participants were recruited opportunistically following a government-funded initiative to provide bariatric surgery to morbidly obese long-term waitlisted patients. Participants self-completed the EQ-5D-5L and AQoL-8D questionnaires pre- and postoperatively. Utility valuations (utilities) and individual/super dimension scores (AQoL- 8D only) were generated.</p> <p><strong>Results:</strong> Participants’ (<i>n</i> = 23) waitlisted time was mean [standard deviation (SD)] 6.5 (2) years, body mass index reduced from 49.3 (9.35) kg/m² preoperatively to 40.8 (7.01) 1 year postoperatively (<i>p</i> = 0.02). One year utilities revealed clinical improvements (both instruments). AQoL-8D improved significantly from baseline to 1 year, with the change twice that of the EQ-5D-5L [EQ-5D-5L: mean (SD) 0.70 (0.25) to 0.78 (0.25); AQoL-8D: 0.51 (0.24) to 0.67 (0.23), <i>p</i> = 0.04], despite the AQoL-8D’s narrower algorithmic range. EQ-5D-5L utility plateaued from 3 months to 1 year. AQoL-8D 1-year utility improvements were driven by Happiness/ Coping/Self-worth (<i>p</i> <0.05), and the Psychosocial super dimension score almost doubled at 1 year (<i>p</i> <0.05). AQoL-8D revealed a wider dispersion of individual utilities.</p> <p><strong>Conclusions:</strong> Ongoing improvements in psychosocial parameters from 3 months to 1 year post-surgery accounted for improvements in overall utilities measured by the AQoL-8D that were not detected by EQ- 5D-5L. Selection of a sensitive instrument is important to adequately assess changes in quality of life and to accurately reflect changes in quality-adjusted life-years for cost-utility analyses and resource allocation in a public healthcare resource-constrained environment.</p>