Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey

Ahmad, Ahmir; Aasheim, Erlend T.; Majeed, Azeem; Millett, Christopher; Saxena, Sonia

doi:10.1177/2042533313512479

Cited by 39 publications

(24 citation statements)

References 19 publications

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“…A national cross-sectional survey in 13,742 English adults indicated that patients eligible for bariatric surgery were more likely to be women, with no formal educational qualifications and retired. [11] These patient characteristics in England differ slightly from those observed in the present study in France, as they were older.…”

Section: Discussioncontrasting

confidence: 85%

Current challenges in providing bariatric surgery in France

et al. 2016

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Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d’Information Inter-régimes de l’Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m2 for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m2, and treatment for obstructive sleep apnea syndrome, diabetes, or depression. Universal health insurance coverage for low-income patients was inversely correlated with the probability of RYGB.Differences in access to surgery have been observed in terms of the patient's profile, geographical variations, and predictors of types of procedures. Several challenges must be met when organizing the medical care of this growing number of patients, when delivering surgery through qualified centers while assuring the quality of long-term follow-up for all patients.

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Section: Discussioncontrasting

confidence: 85%

Current challenges in providing bariatric surgery in France

et al. 2016

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“…23 The main reason for this is thought to be due to a lack of funding. 30 strengths and weaknesses of the study This study had a number of limitations. The most important of these is a selection bias in that data were collected retrospectively from databases of patients who had received bariatric surgery.…”

Section: Meaning Of the Study: Possible Explanations And Implicationsmentioning

confidence: 99%

Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

et al. 2017

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ObjectiveTo investigate the effect of residential location and socioeconomic deprivation on the provision of bariatric surgery.DesignRetrospective cross-sectional ecological study.SettingPatients resident local to one of two specialist bariatric units, in different regions of the UK, who received obesity surgery between 2003 and 2013.MethodsDemographic data were collected from prospectively collected databases. Index of Multiple Deprivation (IMD 2010) was used as a measure of socioeconomic status. Obesity prevalences were obtained from Public Health England (2006). Patients were split into three IMD tertiles (high, median, low) and also tertiles of time. A generalised linear model was generated for each time period to investigate the effect of socioeconomic deprivation on the relationship between bariatric case count and prevalence of obesity. We used these to estimate surgical intervention provided in each population in each period at differing levels of deprivation.ResultsData were included from 1163 bariatric cases (centre 1–414, centre 2–749). Incidence rate ratios (IRRs) were calculated to measure the associations between predictor and response variables. Associations were highly non-linear and changed over the 10-year study period. In general, the relationship between surgical case volume and obesity prevalence has weakened over time, with high volumes becoming less associated with prevalence of obesity.DiscussionAs bariatric services have matured, the associations between demand and supply factors have changed. Socioeconomic deprivation is not apparently a barrier to service provision more recently, but the positive relationships between obesity and surgical volume we would expect to find are absent. This suggests that interventions are not being taken up in the areas of need. We recommend a more detailed national analysis of the relationship between supply side and demand side factors in the provision of bariatric surgery.

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“…Gastric bypass is a commonly applied treatment in this patient group, enabling long-term weight loss and health improvements for most patients [4]. The number of individuals eligible for bariatric surgery exceeds public health care capacity for surgery [5]. It is therefore necessary to prioritize the resources to patients who are anticipated to achieve most health benefits.…”

Section: Introductionmentioning

confidence: 99%