Bariatric Surgery In Canada Research Articles

Experiences and Outcomes of Indigenous Patients Undergoing Bariatric Surgery: a Mixed-Method Scoping Review.

Obesity and type 2 diabetes (T2D) are growing global health concerns. Evidence suggests that Indigenous peoples are at higher lifetime risk of obesity and its associated conditions. Obesity increases the risk of T2D, cardiovascular disease, and all-cause mortality. Bariatric surgery is the most sustained and effective intervention for treating obesity-associated medical problems. This review aims to explore the experiences and outcomes of Indigenous peoples undergoing bariatric surgery in Canada, the USA, Australia, and New Zealand (CANZUS). Analysis of quantitative data revealed that Indigenous patients had fewer bariatric procedures, poorer clinic attendance, similar weight loss outcomes and slightly higher post-operative complication rates. Qualitative data analysis revealed that Indigenous patients living with obesity have a desire to improve their health and quality of life.

Bariatric Surgery Should Be Offered to Active-Duty Military Personnel: a Retrospective Study of the Canadian Armed Forces’ Experience

PurposeLike most Western armies, obesity affects Canadian Armed Forces (CAF) personnel. Bariatric surgery is an effective treatment for obesity. However, this is not yet accepted for active-duty soldiers in most countries. The CAF have approved bariatric surgery since 2005. Our aim is to assess weight loss, resolution of obesity-related comorbidities, and impacts of bariatric surgery on military careers.Materials and MethodsWe retrospectively reviewed the perioperative data, long-term bariatric results, and military outcomes of 108 CAF active-duty military personnel who underwent bariatric surgery in Canada over a 61-month period.ResultsThe cohort was predominantly male (66.7%) with a mean preoperative body mass index (BMI) of 43.6 ± 5.8 kg/m2. Roux-Y gastric bypass was performed in 59 patients, sleeve gastrectomy in 29, and gastric banding in 20. All the surgeries were performed laparoscopically. The total body weight loss at the last follow-up visit was 22.5 ± 11.0%. Remission or improvement of hypertension was observed in 91.2%, diabetes in 85.7%, gastroesophageal reflux disorder (GERD) in 43.6%, sleep apnea in 43.1%, and dyslipidemia in 42.9%. One patient (0.9%) was medically released due to postoperative complications. Fifteen patients (13.9%) were deployed postoperatively. The combined deployable and possibly deployable statuses increased from 35.4% preoperatively to 47.9% postoperatively.ConclusionThis is the largest series of bariatric surgeries performed in active-duty military personnel. Bariatric surgery is effective and safe and improves deployability without impairing military careers. These results are relevant to the military of many industrialized countries. Bariatric surgery should be considered for all active-duty military personnel who meet surgical criteria for the treatment of obesity.Graphical

The effect of the COVID-19 pandemic on bariatric surgery delivery in Edmonton, Alberta: a single-centre experience.

SummaryDelays in the delivery of bariatric surgery in Canada in the context of the COVID-19 pandemic have not been previously explored. Understanding the potential barriers associated with these delays may help in the implementation and delivery of enhanced bariatric protocols, thereby minimizing health care system burden and improving bariatric delivery. We present the experience of a single high-volume, accredited bariatric program in Edmonton, Alberta, in 2020. Although reductions in bariatric cases occurred during lockdown months, the overall number of cases was comparable to 2019 owing to the adoption of strategies aimed at offsetting the burden of hospital resources. These strategies included optimizing patient selection, implementing bariatric Enhanced Recovery After Surgery protocols, and minimizing unnecessary postoperative investigations to allow most patients to be discharged on postoperative day 1. We advocate to continue optimizing bariatric delivery in the face of the COVID-19 pandemic that so disproportionally affects those with severe obesity and its metabolic complications.

Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada

Information on the associations between barriers to delivery of bariatric surgery and poor weight trajectory afterward is lacking. Estimates are needed to inform decisions by administrators and clinicians to improve care. To estimate the difference in patient-years of treatment for diabetes, hypertension, and dyslipidemia and public-payer cost between the Canadian standard and an improved bariatric surgery care pathway. Economic evaluation of a decision analytic model comparing the outcomes of the standard care in Canada with an improved bariatric care pathway with earlier sleeve gastrectomy delivery and better postsurgical weight trajectory. The model was informed by published clinical data (101 studies) and meta-analyses (11 studies) between January and May 2019. Participants were a hypothetical 100-patient cohort with demographic characteristics derived from a Canadian study. Reduction of Canadian mean bariatric surgery wait time by 2.5 years following referral and improvement of patient postsurgery weight trajectory to levels observed in other countries. Modeling weight trajectory after sleeve gastrectomy and resolution rates for comorbidities in Canada in comparison with an improved care pathway to estimate differences in patient-years of comorbidity treatment over 10 years following referral and the associated costs. For the 100-patient cohort (mean [SD] 88.2% [1.4%] female; mean [SD] age, 43.6 [9.2] years; mean [SD] body mass index, 49.4 [8.2]; and mean [SD] comorbidity prevalence of 50.0% [4.1%], 66.0% [3.9%], and 59.3% [4.0%] for diabetes, hypertension, and dyslipidemia, respectively) over 10 years following referral, the improved vs standard care pathway was associated with median reduction in patient-years of treatment of 324 (95% credibility interval [CrI], 249-396) for diabetes, 245 (95% CrI, 163-356) for hypertension, and 255 (95% CrI, 169-352) for dyslipidemia, corresponding to total savings of $900 000 (95% CrI, $630 000 to $1.2 million) for public payers in the base case. Relative to standard of care, the associated reduction in costs was approximately 29% (95% CrI, 20%-42%) in the improved pathway. Sensitivity analyses demonstrated independent associations of earlier surgical delivery and various levels of postsurgical weight trajectory improvements with overall savings. This study suggests that health care burden may be decreased through improvements to delivery and management of patients undergoing sleeve gastrectomy. More data are needed on long-term patient experience with bariatric surgery in Canada to inform better estimates.

A Landscape of Bariatric Surgery in Canada: For the Treatment of Obesity, Type 2 Diabetes and Other Comorbidities in Adults.

Obesity has escalated worldwide and in Canada. Many chronic conditions, including type 2 diabetes, are directly correlated with obesity, and although the benefits and effectiveness of bariatric surgery have been proven in terms of sustained weight loss and improving comorbidities, the procedure is underaccessed and underutilized in Canada. We explored the complex landscape of bariatric surgery in Canada, reviewing the current state and focusing on the volume of procedures nationwide and at the provincial level, the type of surgical procedures performed, their outcomes and their associated complications. Barriers and challenges curbing access to bariatric surgery are also explored. Approximately 8,583 publicly funded bariatric surgeries were performed in 9 of 10 provinces in 2015/2016; Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric banding and biliopancreatic diversion with or without duodenal switch are the most common procedures performed, and coverage varies among provinces and territories. Dedicated bariatric programs have been created and, in some instances, provincial networks have also emerged. Weight loss, resolution of comorbidities and rates of complications in Canada are similar to those found in the literature. The increase in the number of bariatric procedures performed over time has still not met the current demand. The rise in obesity rates, the speed and regional variations in the development and standardization of processes, adequate patient selection, funding and prioritization and gaps in knowledge and attitudes about the merits of bariatric surgery of patients, health providers and policy makers create considerable waiting times and are some of the barriers to better access to bariatric surgery.

The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada.

Previous data demonstrate that patients who receive bariatric surgery at a Center of Excellence are different than those who receive care at non-accredited centers. Canada provides a unique opportunity to naturally exclude confounders such as insurance status, hospital ownership, and lack of access on comparisons between hospitals and surgeons in bariatric surgery outcomes. The objective of this study was to determine the effect of hospital accreditation and other health system factors on all-cause morbidity after bariatric surgery in Canada. This was a population-based study of all patients aged≥18 who received a bariatric procedure in Canada (excluding Quebec) from April 2008 until March 2015. The main outcomes for this study were all-cause morbidity and costs during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24h or required reoperation. Risk-adjusted hierarchical regression models were used to determine predictors of morbidity and cost. Overall, 18,398 patients were identified and the all-cause morbidity rate was 10.1%. Surgeon volume and teaching hospitals were both found to significantly decrease the odds of all-cause morbidity. Specifically, for each increase in 25 bariatric cases per year, the odds of all-cause morbidity was 0.94 times lower (95% CI 0.87-1.00, p=0.03). Teaching hospitals conferred a 0.75 lower odds of all-cause morbidity (95% CI 0.58-0.95, p<0.001). Importantly, formal accreditation was not associated with a decrease in all-cause morbidity within a universal healthcare system. No health system factors were associated with significant cost differences. This national cohort study found that surgeon volume and teaching hospitals predicted lower all-cause morbidity after surgery while hospital accreditation was not a significant factor.

The Effect of Bariatric Surgery on Mobility, Health-Related Quality of Life, Healthcare Resource Utilization, and Employment Status.

A sub-study of the Ontario Bariatric Registry was conducted to evaluate the impact of bariatric surgery on mobility, health-related quality of life (HRQoL), healthcare resource utilization (HRU), and employment status. The 1-year change in mobility following bariatric surgery was evaluated using the mobility domain of the EuroQOL-5D-5L (EQ-5D-5L), which was self-administered at baseline and 1year after bariatric surgery along with questions on HRU. Another questionnaire was used to document employment status at time of surgery and 1year later. The population included 304 individuals (mean age=46years; 85% female). At baseline, 68% of participants had some problems in walking compared to 14% at 1year following surgery (p<0.001). The EQ-5D-5L health utility score increased from 0.73 to 0.90 (p<0.001). The number of hospitalizations increased significantly before and after surgery (p=0.021). Of the 304 study participants, 138 completed the questionnaire and responses indicated that more individuals reported a change in their employment status within 1year following surgery (26%) compared to 1year prior to the surgery (9%) (p<0.001). Within the limitations of this study, there is a suggestion that bariatric surgery has a major impact on mobility and HRQoL. More research is warranted to understand the benefits, costs, and cost-effectiveness of bariatric surgery in Canada.

Perception and Awareness of Bariatric Surgery in Canada: a National Survey of General Surgeons.

The objective of this study was to assess Canadian general surgeons' knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients. A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012. The survey was also disseminated via membership association electronic newsletters in November and December 2012. One hundred sixty-seven questionnaires were completed (104 practicing surgeons, 63 general surgery trainees). Twenty respondents were bariatric surgeons. Among 84 non-bariatric surgeons, 68.3% referred a patient in the last year for bariatric surgery, 79% agreed that bariatric surgery resulted in sustained weight loss, and 81.7% would consider referring a family member. Knowledge gaps were identified in estimates of mortality and morbidity associated with bariatric procedures. The majority of surgeons surveyed have encountered patients with complications from bariatric surgery in the last year. Over 50% of surgeons who do not perform bariatric procedures reported not feeling confident to manage complications, 35.4% reported having adequate resources and equipment to manage morbidly obese patients, and few are able to transfer patients to a bariatric center. Of the respondents, 73.3% reported residency training provided inadequate exposure to bariatric surgery, and 85.3% felt that additional continuing medical education resources would be useful. There appears to be support for bariatric surgery among Canadian general surgeons participating in this survey. Knowledge gaps identified indicate the need for more education and resources to support general surgeons managing bariatric surgical patients.

The State of Bariatric Surgery in Canada.

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.

Assessment of the State of Bariatric Surgery in Canada: Prospective and Retrospective Approaches

s / Can J Diabetes 39 (2015) S38eS74 S69 on the rise over the last 2 decades in Canada. What is troublesome is that these conditions are influenced by a small set of wellestablished, modifiable causes such as an unhealthy diet, and lack of physical activity. Community-based health education interventions seem to have better impact on increasing men’s health literacy and motivation for healthy lifestyle. However, few studies have explored the effectiveness of these interventions among Canadian men. Objectives: 1) to assess the acceptability and feasibility of a community-based intervention aiming to promote healthy practices among men; and 2) to develop a set of recommendations to support men-sensitive healthcare decision making. Methods: Qualitative study using semi-structured interviews with 15 health professionals and 3 focus groups with overweight/ obese men. Verbatim were analyzed using a thematic content analysis. Results/Conclusion: Men-sensitive interventions need to include: 1) health information that is easily retrievable, actionoriented and delivered in simple and concise terms; 2) involve peers, friends and family; 3) shared decision making, comprehensiveness of care, informational continuity, support and humanity practices; 4) awareness campaign and information to address prejudice related to hegemonic masculinity; 5) interventions must be easily integrated into daily life, thus suggesting the inclusion of workplaces and flexible hours; and 6) healthcare managers and Health professionals continuing educational sessions on men’s health needs and expectations. We propose a men-sensitive educational intervention to guide future interventions and research on weight control and management in men.

Current Access to Bariatric Surgery in Canada

Current Access to Bariatric Surgery in Canada

Characteristics of the population eligible for and receiving publicly funded bariatric surgery in Canada

BackgroundBariatric surgery is the most effective current treatment for severe obesity. Capacity to perform surgery within Canada’s public health system is limited and potential candidates face protracted wait times. A better understanding of the gaps between demand for surgery and the capacity to provide it is required. The purpose of this study was to quantify and characterize the bariatric surgery-eligible population in Canada in comparison to surgery-ineligible subjects and surgical recipients.MethodsData from adult (age > 20) respondents of the 2007–09 nationally representative Canadian Health Measures Survey (CHMS) were analyzed to estimate the prevalence and characteristics of the surgery-eligible and ineligible populations. Federally mandated administrative healthcare data (2007–08) were used to characterize surgical recipients.ResultsIn 2007–09, an estimated 1.5 million obese Canadian adults met eligibility criteria for bariatric surgery. 19.2 million were surgery-ineligible (3.4 million obese and 15.8 million non-obese). Surgery-eligible Canadians had a mean BMI of 40.1 kg/m2 (95% CI 39.3 to 40.9 kg/m2) and, compared to the surgery-ineligible obese population, were more likely to be female (62 vs. 44%), 40–59 years old (55 vs. 48%), less educated (43 vs. 35%), in the lowest socioeconomic tertile (41 vs. 34%), and inactive (73 vs. 59%). Self-rated mental health and quality of life were lower and comorbidity was higher in surgery-eligible respondents compared with the ineligible populations. The annual proportion of Canadians eligible for surgery that actually underwent a publicly funded bariatric surgery between 2007–09 was 0.1%. Surgical recipients (n = 847) had a mean age of 43.6 years (SD 11.1) and 82% were female. With the exception of type 2 diabetes, obesity-related comorbidity prevalence was much lower in surgical recipients compared to those eligible for surgery.ConclusionsThe proportion of bariatric surgery-eligible Canadians that undergo publicly funded bariatric surgery is very low. There are notable differences in sociodemographic profiles and prevalence of comorbidities between surgery-eligible subjects and surgical recipients.

Bariatric surgery in Canada — bridging the gap

In this issue, Martin and colleagues1 compare publicly funded Roux-en-Y gastric bypass (RYGB) with adjustable gastric banding (AGB) performed in private clinics as options for the surgical management of obesity. Adjustable gastric banding is now the most common form of bariatric surgery in many parts of the world, including Australia, the United States and Canada. The safety and effectiveness of the AGB procedure has evolved rapidly and substantially over the past decade. Unfortunately there remains a great deal of misunderstanding about the procedure and the requirements for its success. Failure to understand the unique nature and requirements of AGB surgery has led to unjustified conclusions by authors not familiar with the procedure.

Bariatric Surgery in Canada: A Focus on Day Surgery Procedures

Given the rise in obesity rates, increasing capacity for bariatric surgery has become a focus for some provincial planners. Four types of bariatric procedures are now performed in Canada; however, funding for the procedures varies by jurisdiction. This article provides an update to our previous article documenting the volume of in-patient bariatric procedures but focuses on the extent to which Canadians are increasingly receiving bariatric procedures in day surgery settings.

CIHI Survey: Bariatric Surgery in Canada

Bariatric surgery is a treatment option for obese patients when weight-reduction strategies such as lifestyle modifications and pharmacotherapy fail. To date, bariatric surgery has resulted in sustained weight loss; the resolution of diabetes for some patients has also been observed. The objective of this study was to explore changes in-patient bariatric surgery delivery in Canada between 2004-2005 and 2008-2009.

Bariatric Surgery in Canada

Obesity rates for Canadian adults are much higher today than in the past, raising questions about how to achieve healthy weights and mitigate the associated health risks. While not a solution at the population level, bariatric surgery may be a treatment option for a relatively small proportion of obese individuals. In Canada, unlike in the United States, no consistent trend was evident in the use of this surgery between 1996-97 and 2003-04 across the five provinces for which comparable data were available. In 2003-04, bariatric surgeries were performed predominantly for women (87%); the average length of stay in hospital was 5 days; and 1.4% of patients were readmitted to hospital within 7 days of their discharge after surgery.

Characteristics of Patients Undergoing Bariatric Surgery in Canada

The increasing prevalence of obesity has led to an increased use of bariatric surgery in the treatment of severely obese individuals. The characteristics of patients undergoing bariatric procedures outside of clinical studies and on a national level have not previously been reported. Acute-care hospital discharge data from the Canadian Institute for Health Information were analyzed to determine the demographic and clinical features and in-hospital mortality rates of individuals undergoing bariatric surgery in Canada. Data from individuals undergoing surgery in fiscal year 2002/2003 were compared with data from 1993/1994. Over 1100 bariatric surgeries were performed in Canada in 2002/2003, with the vast majority being performed in middle-aged women. Ten percent of patients had hypertension or diabetes, and only 1% or fewer had dyslipidemia or cardiovascular or cerebrovascular disease. Compared with 1993/1994, patients undergoing surgery in 2002/2003 were older, more likely to have diabetes or hypertension, and had shorter hospital stays. In-hospital mortality rates were <1% in both years. In the last decade, there has been a small increase in the average age and the number of patients with concomitant cardiovascular risk factors who are undergoing bariatric procedures in Canada. However, the vast majority of surgeries are being performed in middle-aged women with little cardiovascular comorbidity, and this is likely contributing to very low in-hospital death rates. Such individuals likely represent a highly selected sample of severely obese patients within Canada.

Trends in bariatric surgery in Canada, 1993-2003

The annual number of bariatric surgeries in Canada (excluding Quebec and rural Manitoba) has risen from 78 in 2000–01 to over 1100 procedures in 2002–03, according to the Canadian Institute for Health Information Discharge Abstract Database. Studies have shown that patients initially lose