Outcomes of high‐volume bariatric surgery in the public system

Burton, Paul R.; Brown, Wendy A.; Chen, Richard; Shaw, Kalai; Packiyanathan, Andrew; Bringmann, Ingra; Smith, Andrew; Nottle, Peter

doi:10.1111/ans.13320

Cited by 14 publications

(20 citation statements)

References 14 publications

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“…This finding fits in line with prior research that indicates that self‐modification tactics (such as diet and exercise) are associated with less WL than alternative means (such as bariatric or bypass surgery) and that individuals often report ‘disappointing’ WL results from self‐modification methods . Furthermore, a prior study reported an average patient satisfaction score of 7.7 (of 10) for bariatric surgery and past research indicates that bariatric surgery is associated with improvement in patient quality of life . Also, greater WL, better diet quality and increased physical activity have been found to be predictors of satisfaction with a WL program .…”

Section: Discussionsupporting

confidence: 85%

Treatment satisfaction with different weight loss methods among respondents with obesity

Gupta

2016

Clinical Obesity

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Satisfaction with weight loss (WL) methods has been correlated with the effectiveness, long-term compliance and commitment to weight management. This study explored treatment satisfaction associated with different WL methods among patients with obesity. Cross-sectional data were analysed from the 2012 US National Health and Wellness Survey. Respondents with obesity were categorized as having a WL procedure (e.g., gastric bypass and gastric banding) or using a prescription medication for WL (Sur/Rx), vs. using self-modification WL techniques (e.g., diet, exercise and WL supplements). Overall satisfaction with current WL methods was assessed among the obese and the overweight/obese with type 2 diabetes mellitus (T2DM). Of the 22 927 respondents with obesity, 58.4% took no current action to lose weight, 2.3% were identified as Sur/Rx and 39.3% were identified as self-modification. The Sur/Rx group reported being very/extremely satisfied more frequently than the self-modification group (39.3% vs. 20.2%, P < 0.001). Similarly, respondents with T2DM that were overweight/obese reported higher satisfaction in the Sur/Rx vs. the self-modification group (46.6% vs. 22.7%, P < 0.001). Satisfaction with WL methods was greater for the Sur/Rx vs. the self-modification group. Data suggest the importance of including bariatric surgery and pharmacotherapy as an integral part in comprehensive WL management.

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Section: Discussionsupporting

confidence: 85%

Treatment satisfaction with different weight loss methods among respondents with obesity

Gupta

2016

Clinical Obesity

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“…Four million adult Australians, or 27.2% of the adult population, were estimated to be obese in 2011-12, up from 19.1% in 1995. 7 Although obesity is more prevalent in areas of socioeconomic disadvantage 7 and surgical outcomes appear comparable by funding type, [8][9][10] >90% of bariatric surgery in Australia is privately funded (16 650 primary privately funded procedures were performed in 2015 11 ), a funding pattern that appears similar to that in other countries, such as Mexico and the United Arab Emirates. 12 Not all Australian jurisdictions provide publicly funded bariatric surgery and where it is available the waiting period can be prolonged.…”

Section: Introductionmentioning

confidence: 99%

Population estimates and characteristics of Australians potentially eligible for bariatric surgery: findings from the 2011–13 Australian Health Survey

Sharman

Breslin²,

Кузьминов³

et al. 2018

Aust. Health Review

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The aim of the present study was to determine the potential demand for publicly and privately funded bariatric surgery in Australia. Nationally representative data from the 2011-13 Australian Health Survey were used to estimate the numbers and characteristics of Australians meeting specific eligibility criteria as recommended in National Health and Medical Research Council guidelines for the management of overweight and obesity. Of the 3352037 adult Australians (aged 18-65 years) estimated to be obese in 2011-13, 882441 (26.3%; 95% confidence interval (CI) 23.0-29.6) were potentially eligible for bariatric surgery (accounting for 6.2% (95% CI 5.4-7.1) of the adult population aged 18-65 years (n=14122020)). Of these, 396856 (45.0%; 95% CI 40.4-49.5) had Class 3 obesity (body mass index (BMI) ≥40kgm-2), 470945 (53.4%; 95% CI 49.0-57.7) had Class 2 obesity (BMI 35-39.9kgm-2) with obesity-related comorbidities or risk factors and 14640 (1.7%; 95% CI 0.6-2.7) had Class 1 obesity (BMI 30-34.9kgm-2) with poorly controlled type 2 diabetes and increased cardiovascular risk; 458869 (52.0%; 95% CI 46.4-57.6) were female, 404594 (45.8%; 95% CI 37.3-54.4) had no private health insurance and 309983 (35.1%; 95% CI 28.8-41.4) resided outside a major city. Even if only 5% of Australian adults estimated to be eligible for bariatric surgery sought this intervention, the demand, particularly in the public health system and outside major cities, would far outstrip current capacity. Better guidance on patient prioritisation and greater resourcing of public surgery are needed. In the period 2011-13, 4million Australian adults were estimated to be obese, with obesity disproportionately more prevalent in areas of socioeconomic disadvantage. Bariatric surgery is considered to be cost-effective and the most effective treatment for adults with obesity, but is mainly privately funded in Australia (>90%), with 16650 primary privately funded procedures performed in 2015. The extent to which the supply of bariatric surgery is falling short of demand in Australia is unknown. The present study provides important information for health service planners. For the first time, population estimates and characteristics of those potentially eligible for bariatric surgery in Australia have been described based on the best available evidence, using categories that best approximate the national recommended eligibility criteria. Even if only 5% of those estimated to be potentially eligible for bariatric surgery in Australia sought a surgical pathway (44122 of 882441), the potential demand, particularly in the public health system and outside major cities, would still far outstrip current capacity, underscoring the immediate need for better guidance on patient prioritisation. The findings of the present study provide a strong signal that more funding of public surgery and other effective interventions to assist this population group are necessary.

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“…These positive changes were achieved with a mean 18.5 kg weight loss (13.57% TBWL) at follow-up. This is a more modest weight loss than we have previously described at 5 years [ 29 ] but exceeds the level of weight loss we have previously shown to be correlated with significant health benefits at a threshold of 10%TBWL [ 27 , 30 ].…”

Section: Discussionmentioning

confidence: 45%

“…Two additional questions were asked regarding overall satisfaction with bariatric surgery and were derived from the validated Short Assessment of Patient Satisfaction (SAPS) questionnaire [ 27 , 28 ]. These were as follows: “how would you grade your satisfaction with bariatric surgery on a scale of 0–10?” and “how likely would you be to have the bariatric surgery again?”.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive Analysis of Improvements in Health-Related Quality of Life and Establishment of QALY Gains in a Government-Funded Bariatric Surgical Program with 5-Year Follow-up

et al. 2022

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Purpose Bariatric surgery is an efficacious intervention for substantial and sustained weight reduction in individuals with morbid obesity resulting in health improvements. However, the changes to a patient’s health related quality of life (HRQoL) in the medium to longer term after bariatric surgery have not been adequately characterized. Our aim was to evaluate the change to patient HRQoL 5 years following bariatric surgery in an Australian government-funded hospital system and determine the significance of relationships between change in physical and mental assessment scores and HRQoL utility scores. Materials and Methods We performed a longitudinal panel study of 81 adult patients who underwent primary bariatric surgery at an Australian tertiary government-funded hospital and completed multi-attribute utility (MAU), multi-attribute non-utility (MA), and disease-specific adjusted quality of life (AQoL) questionnaires before and after bariatric surgery. Results At a mean (SD) 5.72 (1.07) years postbariatric surgery, participants demonstrated statistically significant improvements in mean AQoL-8D utility (0.135 (0.21); P < 0.0001), yielding a mean 3.2 (1.67) QALYs gained. Beck Depression Inventory-II scores improved (baseline mean 17.35 (9.57); 5-year mean 14.7 (11.57); P = 0.037). Short Form-36 scores improved in the domains of physical functioning and role limitations due to physical health and general health. Change in depression scores and patient satisfaction with surgery were found to be significant predictors of follow up AQoL utility scores. Conclusions Bariatric surgery improves physical and psychological quality of life measures over 5 years. The improvement of patient QALYs provide insight to the potential cost utility of publicly funded bariatric surgery in the medium term. Graphical abstract

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Outcomes of high‐volume bariatric surgery in the public system

Cited by 14 publications

References 14 publications

Treatment satisfaction with different weight loss methods among respondents with obesity

Treatment satisfaction with different weight loss methods among respondents with obesity

Population estimates and characteristics of Australians potentially eligible for bariatric surgery: findings from the 2011–13 Australian Health Survey

Comprehensive Analysis of Improvements in Health-Related Quality of Life and Establishment of QALY Gains in a Government-Funded Bariatric Surgical Program with 5-Year Follow-up

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