Outcome of three common bariatric procedures in the public sector
Background In Australia, over 90% of bariatric surgery is performed in the private sector by paying patients with health insurance. The demand for government funded services is overwhelming and data are needed on the efficiency, safety and effectiveness of the current range of bariatric procedures i...
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| Veröffentlicht in: | ANZ journal of surgery 2017-11, Vol.87 (11), p.930-934 |
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| container_title | ANZ journal of surgery |
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| creator | Clough, Anthony Hamill, Daniel Jackson, Shane Remilton, Michael Eyre, Rosemarie Callahan, Rosie |
| description | Background
In Australia, over 90% of bariatric surgery is performed in the private sector by paying patients with health insurance. The demand for government funded services is overwhelming and data are needed on the efficiency, safety and effectiveness of the current range of bariatric procedures in a public hospital setting. The aim of this study was to document medium term outcomes of gastric banding (laparoscopic adjustable gastric banding (LAGB)), gastric bypass (Roux‐en‐Y gastric bypass (RYGB)) and sleeve gastrectomy (SG) in a publicly funded programme.
Methods
Primary cases with minimum 18 months’ follow up were included. Hospital usage, complications, weight loss and co‐morbidity outcomes were compared.
Results
A total of 229 patients (125 LAGB, 42 RYGB, 62 SG) were included. Mean weight (body mass index) for LAGB, RYGB and SG was 130.6 (46.3), 137.2 (50.5) and 162.7 (55.2) kg (kg/m2), respectively (P < 0.001). Operative time and hospital stay were longest for RYGB and intensive care stay was longest for SG. Major complications occurred at 0.0%, 11.9% and 12.9% (P < 0.001) and major reoperations occurred over 5 years 11.2%, 21.4% and 6.5% (P = 0.064). Mean (standard deviation) excess weight loss was 29.9% (33.1), 75.7% (31.8) and 52.7% (19.7) with mean follow up of 3.6 years and 79.0% complete data.
Conclusions
In our public bariatric programme, LAGB patients perform relatively poorly. An increased focus on SG may be appropriate as weight loss is more reliable, major reoperation rates are low and follow up less important. Our experience should be useful for those considering how best to structure and fund a public bariatric programme. |
| doi_str_mv | 10.1111/ans.13585 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826665742</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1826665742</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3535-680775b47033e9d495a7374935fff3f4512fcf7ef5fa5666202b40daaaa0f953</originalsourceid><addsrcrecordid>eNp1kE1Lw0AQhhdRbK0e_AMS8KKHtvuZzR5L8QuKPdj7sklmMSXJ1t0E6b93a6oHwbnMDPPMy8uL0DXBMxJrbtowI0xk4gSNCediSomSp8eZcMZG6CKELcYkTZU4RyMqsaQ0U2O0WPdd4RpInE26dw-QxK1xbZIbX5nOV0Wy866AsvcQkqqNECS7Pq_jIUDROX-JzqypA1wd-wRtHh82y-fpav30slyspgUTTEzTDEspci4xY6BKroSRTHLFhLWWWS4ItYWVYIU1Ik1TimnOcWliYasEm6C7QTba-eghdLqpQgF1bVpwfdAko_FLSE4jevsH3bret9GcJkpkKlVcHaj7gSq8C8GD1TtfNcbvNcH6EKuOservWCN7c1Ts8wbKX_InxwjMB-CzqmH_v5JevL4Nkl_DgX_A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1958969492</pqid></control><display><type>article</type><title>Outcome of three common bariatric procedures in the public sector</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Clough, Anthony ; Hamill, Daniel ; Jackson, Shane ; Remilton, Michael ; Eyre, Rosemarie ; Callahan, Rosie</creator><creatorcontrib>Clough, Anthony ; Hamill, Daniel ; Jackson, Shane ; Remilton, Michael ; Eyre, Rosemarie ; Callahan, Rosie</creatorcontrib><description>Background
In Australia, over 90% of bariatric surgery is performed in the private sector by paying patients with health insurance. The demand for government funded services is overwhelming and data are needed on the efficiency, safety and effectiveness of the current range of bariatric procedures in a public hospital setting. The aim of this study was to document medium term outcomes of gastric banding (laparoscopic adjustable gastric banding (LAGB)), gastric bypass (Roux‐en‐Y gastric bypass (RYGB)) and sleeve gastrectomy (SG) in a publicly funded programme.
Methods
Primary cases with minimum 18 months’ follow up were included. Hospital usage, complications, weight loss and co‐morbidity outcomes were compared.
Results
A total of 229 patients (125 LAGB, 42 RYGB, 62 SG) were included. Mean weight (body mass index) for LAGB, RYGB and SG was 130.6 (46.3), 137.2 (50.5) and 162.7 (55.2) kg (kg/m2), respectively (P < 0.001). Operative time and hospital stay were longest for RYGB and intensive care stay was longest for SG. Major complications occurred at 0.0%, 11.9% and 12.9% (P < 0.001) and major reoperations occurred over 5 years 11.2%, 21.4% and 6.5% (P = 0.064). Mean (standard deviation) excess weight loss was 29.9% (33.1), 75.7% (31.8) and 52.7% (19.7) with mean follow up of 3.6 years and 79.0% complete data.
Conclusions
In our public bariatric programme, LAGB patients perform relatively poorly. An increased focus on SG may be appropriate as weight loss is more reliable, major reoperation rates are low and follow up less important. Our experience should be useful for those considering how best to structure and fund a public bariatric programme.</description><identifier>ISSN: 1445-1433</identifier><identifier>EISSN: 1445-2197</identifier><identifier>DOI: 10.1111/ans.13585</identifier><identifier>PMID: 27072289</identifier><language>eng</language><publisher>Melbourne: Wiley Publishing Asia Pty Ltd</publisher><subject>Adult ; Australia - epidemiology ; Banding ; bariatric surgery ; Bariatric Surgery - adverse effects ; Bariatric Surgery - economics ; Bariatric Surgery - methods ; Body mass ; Body Mass Index ; Body size ; Body weight loss ; Comorbidity ; Complications ; Female ; Follow-Up Studies ; Gastrectomy ; Gastrectomy - adverse effects ; Gastrectomy - methods ; gastric banding ; Gastric bypass ; Gastric Bypass - adverse effects ; Gastric Bypass - methods ; Gastrointestinal surgery ; Gastroplasty - adverse effects ; Gastroplasty - methods ; government funded ; Health Resources - utilization ; Humans ; Laparoscopy ; Laparoscopy - methods ; Length of Stay ; Male ; medicare ; medium term ; Middle Aged ; Morbidity ; Operative Time ; Patients ; Private sector ; public ; Public sector ; Public Sector - statistics & numerical data ; Reoperation - statistics & numerical data ; sleeve gastrectomy ; Surgery ; Treatment Outcome ; Weight loss ; Weight Loss - physiology</subject><ispartof>ANZ journal of surgery, 2017-11, Vol.87 (11), p.930-934</ispartof><rights>2016 Royal Australasian College of Surgeons</rights><rights>2016 Royal Australasian College of Surgeons.</rights><rights>2017 Royal Australasian College of Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-680775b47033e9d495a7374935fff3f4512fcf7ef5fa5666202b40daaaa0f953</citedby><cites>FETCH-LOGICAL-c3535-680775b47033e9d495a7374935fff3f4512fcf7ef5fa5666202b40daaaa0f953</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fans.13585$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fans.13585$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27072289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Clough, Anthony</creatorcontrib><creatorcontrib>Hamill, Daniel</creatorcontrib><creatorcontrib>Jackson, Shane</creatorcontrib><creatorcontrib>Remilton, Michael</creatorcontrib><creatorcontrib>Eyre, Rosemarie</creatorcontrib><creatorcontrib>Callahan, Rosie</creatorcontrib><title>Outcome of three common bariatric procedures in the public sector</title><title>ANZ journal of surgery</title><addtitle>ANZ J Surg</addtitle><description>Background
In Australia, over 90% of bariatric surgery is performed in the private sector by paying patients with health insurance. The demand for government funded services is overwhelming and data are needed on the efficiency, safety and effectiveness of the current range of bariatric procedures in a public hospital setting. The aim of this study was to document medium term outcomes of gastric banding (laparoscopic adjustable gastric banding (LAGB)), gastric bypass (Roux‐en‐Y gastric bypass (RYGB)) and sleeve gastrectomy (SG) in a publicly funded programme.
Methods
Primary cases with minimum 18 months’ follow up were included. Hospital usage, complications, weight loss and co‐morbidity outcomes were compared.
Results
A total of 229 patients (125 LAGB, 42 RYGB, 62 SG) were included. Mean weight (body mass index) for LAGB, RYGB and SG was 130.6 (46.3), 137.2 (50.5) and 162.7 (55.2) kg (kg/m2), respectively (P < 0.001). Operative time and hospital stay were longest for RYGB and intensive care stay was longest for SG. Major complications occurred at 0.0%, 11.9% and 12.9% (P < 0.001) and major reoperations occurred over 5 years 11.2%, 21.4% and 6.5% (P = 0.064). Mean (standard deviation) excess weight loss was 29.9% (33.1), 75.7% (31.8) and 52.7% (19.7) with mean follow up of 3.6 years and 79.0% complete data.
Conclusions
In our public bariatric programme, LAGB patients perform relatively poorly. An increased focus on SG may be appropriate as weight loss is more reliable, major reoperation rates are low and follow up less important. Our experience should be useful for those considering how best to structure and fund a public bariatric programme.</description><subject>Adult</subject><subject>Australia - epidemiology</subject><subject>Banding</subject><subject>bariatric surgery</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Bariatric Surgery - economics</subject><subject>Bariatric Surgery - methods</subject><subject>Body mass</subject><subject>Body Mass Index</subject><subject>Body size</subject><subject>Body weight loss</subject><subject>Comorbidity</subject><subject>Complications</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastrectomy - methods</subject><subject>gastric banding</subject><subject>Gastric bypass</subject><subject>Gastric Bypass - adverse effects</subject><subject>Gastric Bypass - methods</subject><subject>Gastrointestinal surgery</subject><subject>Gastroplasty - adverse effects</subject><subject>Gastroplasty - methods</subject><subject>government funded</subject><subject>Health Resources - utilization</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>medicare</subject><subject>medium term</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Operative Time</subject><subject>Patients</subject><subject>Private sector</subject><subject>public</subject><subject>Public sector</subject><subject>Public Sector - statistics & numerical data</subject><subject>Reoperation - statistics & numerical data</subject><subject>sleeve gastrectomy</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Weight loss</subject><subject>Weight Loss - physiology</subject><issn>1445-1433</issn><issn>1445-2197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1Lw0AQhhdRbK0e_AMS8KKHtvuZzR5L8QuKPdj7sklmMSXJ1t0E6b93a6oHwbnMDPPMy8uL0DXBMxJrbtowI0xk4gSNCediSomSp8eZcMZG6CKELcYkTZU4RyMqsaQ0U2O0WPdd4RpInE26dw-QxK1xbZIbX5nOV0Wy866AsvcQkqqNECS7Pq_jIUDROX-JzqypA1wd-wRtHh82y-fpav30slyspgUTTEzTDEspci4xY6BKroSRTHLFhLWWWS4ItYWVYIU1Ik1TimnOcWliYasEm6C7QTba-eghdLqpQgF1bVpwfdAko_FLSE4jevsH3bret9GcJkpkKlVcHaj7gSq8C8GD1TtfNcbvNcH6EKuOservWCN7c1Ts8wbKX_InxwjMB-CzqmH_v5JevL4Nkl_DgX_A</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Clough, Anthony</creator><creator>Hamill, Daniel</creator><creator>Jackson, Shane</creator><creator>Remilton, Michael</creator><creator>Eyre, Rosemarie</creator><creator>Callahan, Rosie</creator><general>Wiley Publishing Asia Pty Ltd</general><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201711</creationdate><title>Outcome of three common bariatric procedures in the public sector</title><author>Clough, Anthony ; Hamill, Daniel ; Jackson, Shane ; Remilton, Michael ; Eyre, Rosemarie ; Callahan, Rosie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-680775b47033e9d495a7374935fff3f4512fcf7ef5fa5666202b40daaaa0f953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Australia - epidemiology</topic><topic>Banding</topic><topic>bariatric surgery</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Bariatric Surgery - economics</topic><topic>Bariatric Surgery - methods</topic><topic>Body mass</topic><topic>Body Mass Index</topic><topic>Body size</topic><topic>Body weight loss</topic><topic>Comorbidity</topic><topic>Complications</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastrectomy - methods</topic><topic>gastric banding</topic><topic>Gastric bypass</topic><topic>Gastric Bypass - adverse effects</topic><topic>Gastric Bypass - methods</topic><topic>Gastrointestinal surgery</topic><topic>Gastroplasty - adverse effects</topic><topic>Gastroplasty - methods</topic><topic>government funded</topic><topic>Health Resources - utilization</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>medicare</topic><topic>medium term</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Operative Time</topic><topic>Patients</topic><topic>Private sector</topic><topic>public</topic><topic>Public sector</topic><topic>Public Sector - statistics & numerical data</topic><topic>Reoperation - statistics & numerical data</topic><topic>sleeve gastrectomy</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Weight loss</topic><topic>Weight Loss - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Clough, Anthony</creatorcontrib><creatorcontrib>Hamill, Daniel</creatorcontrib><creatorcontrib>Jackson, Shane</creatorcontrib><creatorcontrib>Remilton, Michael</creatorcontrib><creatorcontrib>Eyre, Rosemarie</creatorcontrib><creatorcontrib>Callahan, Rosie</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>ANZ journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Clough, Anthony</au><au>Hamill, Daniel</au><au>Jackson, Shane</au><au>Remilton, Michael</au><au>Eyre, Rosemarie</au><au>Callahan, Rosie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of three common bariatric procedures in the public sector</atitle><jtitle>ANZ journal of surgery</jtitle><addtitle>ANZ J Surg</addtitle><date>2017-11</date><risdate>2017</risdate><volume>87</volume><issue>11</issue><spage>930</spage><epage>934</epage><pages>930-934</pages><issn>1445-1433</issn><eissn>1445-2197</eissn><abstract>Background
In Australia, over 90% of bariatric surgery is performed in the private sector by paying patients with health insurance. The demand for government funded services is overwhelming and data are needed on the efficiency, safety and effectiveness of the current range of bariatric procedures in a public hospital setting. The aim of this study was to document medium term outcomes of gastric banding (laparoscopic adjustable gastric banding (LAGB)), gastric bypass (Roux‐en‐Y gastric bypass (RYGB)) and sleeve gastrectomy (SG) in a publicly funded programme.
Methods
Primary cases with minimum 18 months’ follow up were included. Hospital usage, complications, weight loss and co‐morbidity outcomes were compared.
Results
A total of 229 patients (125 LAGB, 42 RYGB, 62 SG) were included. Mean weight (body mass index) for LAGB, RYGB and SG was 130.6 (46.3), 137.2 (50.5) and 162.7 (55.2) kg (kg/m2), respectively (P < 0.001). Operative time and hospital stay were longest for RYGB and intensive care stay was longest for SG. Major complications occurred at 0.0%, 11.9% and 12.9% (P < 0.001) and major reoperations occurred over 5 years 11.2%, 21.4% and 6.5% (P = 0.064). Mean (standard deviation) excess weight loss was 29.9% (33.1), 75.7% (31.8) and 52.7% (19.7) with mean follow up of 3.6 years and 79.0% complete data.
Conclusions
In our public bariatric programme, LAGB patients perform relatively poorly. An increased focus on SG may be appropriate as weight loss is more reliable, major reoperation rates are low and follow up less important. Our experience should be useful for those considering how best to structure and fund a public bariatric programme.</abstract><cop>Melbourne</cop><pub>Wiley Publishing Asia Pty Ltd</pub><pmid>27072289</pmid><doi>10.1111/ans.13585</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Australia - epidemiology Banding bariatric surgery Bariatric Surgery - adverse effects Bariatric Surgery - economics Bariatric Surgery - methods Body mass Body Mass Index Body size Body weight loss Comorbidity Complications Female Follow-Up Studies Gastrectomy Gastrectomy - adverse effects Gastrectomy - methods gastric banding Gastric bypass Gastric Bypass - adverse effects Gastric Bypass - methods Gastrointestinal surgery Gastroplasty - adverse effects Gastroplasty - methods government funded Health Resources - utilization Humans Laparoscopy Laparoscopy - methods Length of Stay Male medicare medium term Middle Aged Morbidity Operative Time Patients Private sector public Public sector Public Sector - statistics & numerical data Reoperation - statistics & numerical data sleeve gastrectomy Surgery Treatment Outcome Weight loss Weight Loss - physiology |
| title | Outcome of three common bariatric procedures in the public sector |
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