The State of Bariatric Surgery in Canada.

Abstract

Obesity is estimated to affect at least one in five adults in Canada, and it poses a significant population health challenge. Obesity increases the risk of other chronic health conditions such as type 2 diabetes and hypertension. Many interventions can help individuals with obesity lose weight and improve their quality of life including lifestyle changes, medical counselling and medication, and evidence shows that bariatric surgery is another tool that can be used to achieve significant weight loss. Improved access to bariatric surgery is an identified priority in several provinces. Administrative data on bariatric surgeries performed in Canadian hospitals are captured in the Canadian Institute for Health Information’s Discharge Abstract Database, Hospital Morbidity Database and National Ambulatory Care Reporting System, and provides information on important aspects of a patient’s hospital care. The analysis presented here is an update to our report released in May of 2014 (available free of charge at https://secure.cihi.ca/estore/productFamily. htm?locale=en&pf=PFC2609). Almost four out of five (78%) individuals who undergo bariatric surgery are women. The typical patient is in her forties and has obesity, as well as other conditions such as diabetes, hypertension or sleep disorders. These characteristics have remained relatively consistent since 2006–2007. In total, 6,525 bariatric surgeries were performed in Canadian hospitals in 2013–2014. The volume of surgeries has increased more than four-fold over the past seven years, and this reflects the efforts of governments to expand access. Capacity has greatly increased in Ontario, where almost half (43%) of all surgeries are currently performed, as well as in other provinces including Quebec. Gastric bypass (3,158 surgeries in 2013–2014) is currently the most common type of bariatric procedure performed in Canadian hospitals. Recent increases in the number of sleeve gastrectomy procedures have been paralleled by decreases in the number of gastric banding procedures (410 and 1,112 surgeries in 2009–2010 compared to 2,362 and 702 surgeries in 2013–2014, respectively). Additionally, the surgical approach has changed over time as almost all (98%) bariatric surgeries are now performed laparoscopically compared with 65% in 2006–2007. In 2013–2014, 5% of bariatric surgery patients experienced complications during their hospitalization for the surgery and 5% were readmitted to hospital within 30 days of discharge. Complication and readmission rates have shown steady declines over time. Some patients show a noticeable increase in their pattern of healthcare utilization in the years following bariatric surgery. This may be due to follow-up care directly related to their surgery or may represent deferred procedures such as joint replacements or hernia repairs that could not be provided to patients prior to significant weight loss. Studies with longer follow-up periods will help to clarify how bariatric surgery affects long-term healthcare utilization and the associated costs. Bariatric surgery can be an effective treatment for obesity and its related comorbidities. Variation in public coverage and capacity across jurisdictions will continue to shape the evolving landscape of bariatric surgery in Canada.