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Metabolic outcomes after bariatric surgery for Indigenous patients in Ontario

Olivia Lovrics, BSc, MScA1, Aristithes G Doumouras, MD, MPH1, Scott Gmora, MD2, Mehran Anvari, MB, BS, PhD, MD2, Dennis Hong, MSc, MD2. 1St Joseph’s Healthcare, Hamilton, Ontario, Canada, 2McMaster University, Hamilton, Ontario, Canada

Introduction: In 2013, over 18% of Canada’s general adult population was considered obese (BMI > 30 kg/m2), compared to 25.7% of Canada’s First Nations, Inuit, and Metis (collectively, Indigenous) peoples. Obesity-related comorbidities affect indigenous Canadians more than non-indigenous, contributing to a lower life-expectancy in indigenous Canadians than non-indigenous. Bariatric surgery has been demonstrated to be an effective treatment for obesity, but this treatment has not been studied in Canadian indigenous populations. Accordingly, the purpose of this study is to determine the effect of bariatric surgery on metabolic outcomes for indigenous populations.

Methods and Procedures: Prospectively collected data from the Ontario Bariatric Registry was used in this study. All individuals who underwent bariatric surgery between March 2010 and February 2018 were included in initial analysis. Post-operative outcomes in the database include diabetes, hypertension, GERD, and medication requirements. Demographics, baseline characteristics, and univariate outcomes were assessed using either the Pearson Chi-Squared test or t-test. A multivariable regression model for BMI change at 6 months and 1 year was utilized with both a complete case analysis and multiple imputation.

Results: Overall, 16,629 patients were identified of which 338 self-identified as indigenous, 13,502 as non-indigenous, and 2,789 did not enter a designation and were excluded. Overall follow-up rates were 67.5% at 6-months and 52.0% at 1-year. Baseline demographics were not statistically different between indigenous and non-indigenous patients; however, rates of hypertension (p=0.03) and diabetes (<0.001) were higher in indigenous populations. Indigenous patients utilized pre-surgical medical and allied healthcare specialists, investigations and procedures at rates similar to non-Indigenous patients, except in the cases of physiotherapists, psychologists, nurse practitioners and diabetes nurses, who were more likely to be seen by indigenous patients. In univariable analysis, at 1 year, change in BMI was similar between groups (Indigenous: 15.8±6.0 kg/m2; Non-indigenous: 16.1±5.6 kg/m2, p=0.362). After adjustment, BMI change for indigenous patients, compared to non-indigenous, was not different at 6-months (Effect Size =0.07, 95%CI -0.45 to 0.58, p=0.803) and 1-year (Effect Size =-0.24, 95%CI -0.93 to 0.45, p=0.489), respectively.  Rates of diabetes, hypertension, GERD, and medication use were similar at 1-year between the two populations despite differences at baseline.

Conclusions: Indigenous Ontarians appear to respond as well as non-indigenous Ontarians to bariatric surgery in terms of weight loss and resolution of relevant comorbidities. Accordingly, this treatment, and the standard outcomes associated with it, should be considered for all indigenous patients who qualify.  


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93884

Program Number: P157

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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