Toward the Rational and Equitable Use of Bariatric Surgery

Flum, David R.; Khan, Tipu; Dellinger, E. Patchen

doi:10.1001/jama.298.12.1442

Cited by 75 publications

(45 citation statements)

References 23 publications

(25 reference statements)

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“…1 However, surgery is difficult to access in Canada because of high demand and limited capacity, which has led to the emergence of protracted, multiyear wait times. 17,18 Currently, most patients are selected for surgery on the basis of BMI thresholds alone and have few obesityrelated comorbidities. The practice of selecting patients using BMI alone has been criticized as inaccurate and arbitrary and may result in the selection of patients who are least likely to benefit from weight reduction.…”

Section: Main Findingsmentioning

confidence: 99%

Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity

Padwal

Pajewski

Allison

et al. 2011

CMAJ

309

213

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Section: Main Findingsmentioning

confidence: 99%

Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity

Padwal

Pajewski

Allison

et al. 2011

CMAJ

309

213

View full text Add to dashboard Cite

“…In Canada, the US and the United Kingdom, far less than 1% of eligible patients currently receive a bariatric procedure and wait lists in Canada average 5 years 63 . In addition, concerns have been raised regarding potential inequities in access, as men, patients of lower socioeconomic status, ethnic minorities and individuals with more comorbidity appear under-represented amongst surgical recipients 75 . The absence of a widely accepted triage system for selecting surgical candidates is also a major impediment to streamlining wait lists 76 .…”

Section: Commentmentioning

confidence: 99%

Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence

et al. 2011

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“…11,12 Even if future surgical capacity is dramatically increased, only a very small proportion of eligible candidates will be able to access surgery, and a dilemma exists in terms of how to optimally allocate this scarce resource. 11,13 Currently, no universally accepted prioritization criteria exist. In Canada, eligible candidates are placed in the queue on a first come, first served basis.…”

Section: E Xtreme Obesity (Body Mass Index [Bmi] ≥ 35) Inmentioning

confidence: 99%

Prioritization and willingness to pay for bariatric surgery: the patient perspective

et al. 2014

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Background: Access to publicly funded bariatric surgery is limited, potential candidates face lengthy waits, and no universally accepted prioritization criteria exist. We examined patients' perspectives regarding prioritization for surgery. Methods:We surveyed consecutively recruited patients awaiting bariatric surgery about 9 hypothetical scenarios describing patients waiting for surgery. Respondents were asked to rank the priority of these hypothetical patients on the wait list relative to their own. Scenarios examined variations in age, clinical severity, functional impairment, social dependence and socioeconomic status. Willingness to pay for faster access was assessed using a 5-point ordinal scale and analyzed using multivariable logistic regression. Results:The 99 respondents had mean age of 44.7 ± 9.9 years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± 9.4 months. Respondents assigned similar priority to hypothetical patients with characteristics identical to theirs (p = 0.22) and higher priority (greater urgency) to those exhibiting greater clinical severity (p < 0.001) and functional impairment (p = 0.003). Lower priority was assigned to patients at the extremes of age (p = 0.006), on social assistance (p < 0.001) and of high socioeconomic status (p < 0.001). Most (85%) respondents disagreed with payment to expedite access, although participants earning more than $80 000/year were less likely to disagree. Conclusion:Most patients waiting for bariatric surgery consider greater clinical severity and functional impairments related to obesity to be important prioritization indicators and disagreed with paying for faster access. These findings may help inform future efforts to develop acceptable prioritization strategies for publicly funded bariatric surgery.

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Toward the Rational and Equitable Use of Bariatric Surgery

Cited by 75 publications

References 23 publications

Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity

Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity

Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence

Prioritization and willingness to pay for bariatric surgery: the patient perspective

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