Bariatric Surgery in Brazilian Public Health System: The Good, the Bad and the Ugly, or a Long Way to Go. Yellow Sign!

Abstract

Background:In Brazil, there has been a significant increase in obesity rates in all age groups. Data from 2017 show that obesity affects 19% of the population. Due to the magnitude of the problem, public health policies have aimed to prevent complications related to obesity by increasing the offerfor bariatric surgeries. Aim:To analyze the current status of bariatric surgery performed in the Brazilian public health system, including data from macroregions and also the effect of digestive surgery training on the number of procedures. Methods:The database of the public health registry (DATASUS) was assessedbetween 2008 and 2018 for descriptive analysis of data and evaluation of the selected parameters. The main surgical techniques, comorbidities, mortality and the costs profile of the system were evaluated. Results:There was a 339% increase in the number of bariatric surgeries in the period evaluated. Gastric bypass was performed in 94% of cases whereas sleeve in 2.4%. Other techniques were used in 3.6%. There were discrepancies in the number of surgeries performed in different regions of the country. Conclusion:There was a considerable advance in the number of bariatric surgeries performed by the public health system between 2008 and 2018. However, there is a need to increase the offer of this service and alsospecialized training, as well as a correction in the distribution of these procedures in the national territory to achieve integrality among its users.

Can Stature, Abdominal Perimeter and Bmi Index Predict Possible Cardiometabolic Risks in Future Obesity?

“…O besity has become a worldwide epidemic 7,27 . Although there are indications that it is metabolically healthy, there is consensus on its harm and various risks present in obese individuals who have visceral fat deposition 5,20,23,28 . The greater the volume and the percentage of body fat with the increase in body mass index (BMI), there is also deposition in visceral fat 3 .…”

“…Regarding the measurement of the abdominal perimeter (waist), the adequacy of the cutoff point established at 102 cm for men and 88 cm for women 12 is questioned for populations of different ethnicities. Some studies with lower levels -94 cm for men and 80 cm for women -have been considered more appropriate 6,10,18,20,28 . It is still mentioned that different ethnicities have different somatotypes, and consequently different fat distributions, so that cut-off values predictive of risk in a given population may not be valid for others.…”

Impacts of bariatric surgery on costs and health outcomes of patients in Brazil: Interrupted time series analysis of multi-panel data

“…The Brazilian public health system offer freely bariatric surgery aiming to prevent possible complications related to obesity, but the lack of more accurate information about costs of the surgery, pre-and post-hospitalization and possible effectiveness can delay the spread of this procedure in the population. 47 Data information on multiple health outcomes associated with health care costs of bariatric surgery throughout presurgery period until follow-up at individual level may provide important information for public policy decision making; particularly considering data from high complexity hospital considered reference health care institution in Brazil. [48][49][50][51][52][53] The current study addresses the limitations in the literature by presenting an analysis of patient-level data in Brazil to examine the impact of bariatric surgery on multiple outcomes (including anthropometric, hemodynamic and biochemical parameters) using an interrupted time series approach.…”

Vertical Gastrectomy vs. Extended Vertical Gastrectomy: What Is the Impact on Gastroesophageal Reflux Disease in Obese Rats?

“…The presence of GERD was pointed out as a contraindication for VG by 57% of specialists during the International Sleeve Gastrectomy Expert Panel Consensus Statement in 2012 24 . However, the subject remains controversial, and there is still no consensus in the literature on the subject 1,3,5,20,21,31,32,35,36 .…”