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Obesity Surgery

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01-08-2018 | Original Contributions

Variability in Bariatric Surgical Care Among Various Centers: a Survey of All Bariatric Surgeons in the Province of Quebec, Canada

Authors: Amin Andalib, Philippe Bouchard, Alexandre Bougie, Sarah-Eve Loiselle, Sebastian Demyttenaere, Olivier Court

Published in: Obesity Surgery | Issue 8/2018

Abstract

Background

Despite an increase in bariatric surgery across Quebec, Canada, access is still limited. Furthermore, there are differences in resources and multidisciplinary capabilities of providing centers that may impact quality of care and outcomes.

Methods

We performed an online survey of all bariatric surgeons in the province of Quebec, Canada, using the LimeSurvey software.

Results

Forty-six surgeons from 15 centers were surveyed. Response rate was 87% (n = 40). Only 13 (35%) surgeons have any formal fellowship training in bariatric surgery and 74% perform > 50 cases/year. All surgeons perform sleeve gastrectomy, 34% do duodenal switch, and 44% provide major revisions. Thirty-one surgeons (77%) identified access to operating room as the main cause for surgical delays. While most surgeons (52%) considered < 6 months as an acceptable wait-time, only 33% achieved this in their practice. Majority (70%) favored a centralized provincial referral system. Patient’s geographical convenience, procedural choice, and multidisciplinary capabilities of providing centers are identified as important determinants for centralized referrals (93, 78, and 55%, respectively). Virtually, all supported accreditation/designation of centers and creation of Quebec Bariatric Network for quality control and research (85 and 98%, respectively).

Conclusion

Bariatric surgical patterns vary among designated centers in Quebec, Canada. Access to multidisciplinary care and surgeon’s fellowship training may be contributing factors for the observed variability. Wait-lists are long and timely access to surgery remains an issue. There is near consensus for establishing a centralized referral system, designation of referral vs. primary centers, and creating Quebec Bariatric Network for research and quality control.

Navaneelan T, Janz T. Adjusting the scales: obesity in the Canadian population after correcting for respondent bias. Statistics Canada. May 2014; catalogue no. 82-624-X. Health at a Glance

Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.CrossRef

Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration, Lu Y, Hajifathalian K, et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet. 2014;383(9921):970–83.CrossRef

Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378(9793):815–25.CrossRefPubMed

Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg. 2007;17(5):601–7.CrossRefPubMed

Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32(Suppl 7):S93–7.CrossRef

Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23. discussion 23-4CrossRefPubMedPubMedCentral

Bariatric Surgery in Canada. Canadian Institute for Health Information. 2015. Available at: https://www.cihi.ca/en/bariatric-surgery-in-canada-infographic. Accessed 01 Dec 2017.

Canadian Obesity Network-Réseau canadien en obésité. Report Card on Access to Obesity Treatment for Adults in Canada 2017. Canadian Obesity Network Inc 2017. Available at: http://www.obesitynetwork.ca/files/FULLREPORTfinalENG.pdf. Accessed 01 Dec 2017.

10.

L’organisation de la chirurgie bariatrique au Québec: Plan d’action. La Direction des communications du ministère de la Santé et des Services sociaux du Québec. 2009. Available at: http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2009/09-932-01.pdf. Accessed 01 Dec 2017.

11.

Ontario Bariatric Network: Surgical program. 2015. Available at: http://www.ontariobariatricnetwork.ca/our-programs/surgical-program. Accessed 01 Dec 2017.

12.

Abraham A, Ikramuddin S, Jahansouz C, et al. Trends in bariatric surgery: procedure selection, Revisional surgeries, and readmissions. Obes Surg. 2016;26(7):1371–7.CrossRefPubMed

13.

Khorgami Z, Shoar S, Andalib A, et al. Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017;13(5):774–8.CrossRefPubMed

14.

Sanchez-Pernaute A, Herrera MA, Perez-Aguirre ME, et al. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg. 2010;20(12):1720–6.CrossRefPubMed

15.

Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3(1):29–35.CrossRefPubMed

16.

Doumouras AG, Saleh F, Anvari S, et al. The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada. Surg Endosc. 2017;31(11):4816–23.CrossRefPubMed

17.

Ali MR, Tichansky DS, Kothari SN, et al. Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass. Surg Endosc. 2010;24(1):138–44.CrossRefPubMed

18.

Agrawal S. Impact of bariatric fellowship training on perioperative outcomes for laparoscopic roux-en-Y gastric bypass in the first year as consultant surgeon. Obes Surg. 2011;21(12):1817–21.CrossRefPubMed

19.

Aminian A, Chaudhry RM, Khorgami Z, et al. A challenge between trainee education and patient safety: does fellow participation impact postoperative outcomes following bariatric surgery? Obes Surg. 2016;26(9):1999–2005.CrossRefPubMed

20.

Jafari MD, Jafari F, Young MT, et al. Volume and outcome relationship in bariatric surgery in the laparoscopic era. Surg Endosc. 2013;27(12):4539–46.CrossRefPubMed

21.

Gebhart A, Young M, Phelan M, et al. Impact of accreditation in bariatric surgery. Surg Obes Relat Dis. 2014;10(5):767–73.CrossRefPubMed

22.

Azagury D, Morton JM. Bariatric surgery outcomes in US accredited vs non-accredited centers: a systematic review. J Am Coll Surg. 2016;223(3):469–77.CrossRefPubMed

23.

Ibrahim AM, Ghaferi AA, Thumma JR, et al. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg. 2017;152(7):629–36.CrossRefPubMedPubMedCentral

24.

Access to specialized medical services-Bariatric surgery. 2018. Available at: http://wpp01.msss.gouv.qc.ca/appl/g74web/carte.asp. Accessed January 25, 2018.

25.

Saleh F, Doumouras AG, Gmora S, et al. Outcomes the Ontario bariatric network: a cohort study. CMAJ Open. 2016;4(3):E383–E9.CrossRefPubMedPubMedCentral

26.

Elnahas A, Jackson TD, Okrainec A, et al. The effect of the Ontario bariatric network on health services utilization after bariatric surgery: a retrospective cohort study. CMAJ OpenS. 2016;4(3):E489–E95.CrossRef

27.

Aird LN, Hong D, Gmora S, et al. The impact of a standardized program on short and long-term outcomes in bariatric surgery. Surg Endosc. 2017;31(2):801–8.CrossRefPubMed

28.

Sharma AM. Inequalities in access to bariatric surgery in Canada. CMAJ. 2016;188(5):317–8.CrossRefPubMedPubMedCentral

29.

Doumouras AG, Anvari S, Breau R, et al. The effect of an online referral system on referrals to bariatric surgery. Surg Endosc. 2017;31(12):5127–34.CrossRefPubMed

Title: Variability in Bariatric Surgical Care Among Various Centers: a Survey of All Bariatric Surgeons in the Province of Quebec, Canada
Authors: Amin Andalib
Philippe Bouchard
Alexandre Bougie
Sarah-Eve Loiselle
Sebastian Demyttenaere
Olivier Court
Publication date: 01-08-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 8/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-3157-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Variability in Bariatric Surgical Care Among Various Centers: a Survey of All Bariatric Surgeons in the Province of Quebec, Canada

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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