PSY73 - Variability of Clinical Practice for Bariatric Surgery in Spain

Abstract

Geographical variations in medical practice are expected to be small when the evidence about a particular technology is abundant. This would be the case of bariatric surgery (BS), which has been demonstrated to be an effective intervention to promote weight-loss in patients with indications for this procedure (PWI). Moreover, BS has recently proven to be cost-effective and drive long-term savings, compared to a “do-nothing” intervention, for the Spanish National Health System. The objective of this research is to analyze the differences in adoption of BS among the different Spanish Autonomous Communities (Regions). Ecologic design. A retrospective analysis of the Spanish 2011 Health System Survey was conducted to estimate the prevalence of adult PWI for BS in each Region. The results were therefore extrapolated to the total regional adult population reported by the National Institute of Statistics for 2011. The total number of bariatric surgeries by Regions during 2011were retrieved from the database of the National Health Ministry (ICD-9-CM: 44.31, 44.39, 44.38, 44.95 and 44.69) Variation in the annual provision of BS was large, ranging from 0.81% of patients with indication for Murcia, to 0.11% in Navarra. For the rest of Regions, the percentage of PWI operated in 2011 was: Madrid=0.62%; Castilla y León=0.60%; Aragón=0.35%; Cataluña=0.33%; Pais Vasco=0.32%; Com. Valenciana=0.30%; Cantabria=0.30%; Canarias=0.30%; Extremadura=0.23%; Galicia=0.22%; Asturias=0.19%; Andalucía=0.18%; Castilla La Mancha=0.15%; Baleares=0.14% and La Rioja=0.13%. These results raise the hypothesis that living in a certain Region may strongly affect the probability of a PWI receiving BS. In such case, this variability should be tackled, particularly in a country where most patients are supposed to have access to this treatment without any copayment. Further research with more accurate estimations and multilevel analysis models would be desirable to confirm these results.