The Impact of Standardization on Short and Longterm Outcomes in Bariatric Surgery

Lisa N Aird, MD, MHSc1, Ruth Breau1, Dennis Hong, MD, MSc2, Scott Gmora2, Mehran Anvari3. 1Centre for Minimal Access Surgery, 2St. Joseph’s Healthcare, 3Ontario Bariatric Network

Introduction: The purpose of this study is to determine if there has been an improvement in morbidity, mortality, and clinical outcomes since 2010, when the Ontario Bariatric Network (OBN) led a province-wide initiative to establish standardized care for bariatric patients.  This has led to the creation of 9 bariatric centers, a centralized referral system, and a registry to gather patient data.  Standardization of procedures has progressed yearly, including guidelines for pre-operative assessment, patient selection and peri and post-operative care. 

Methods and Procedures: Analysis of the OBN registry data was performed by fiscal year between April 2010-March 2015.  Three-month post-operative complication rates and 30-day post-operative mortality were calculated.  The mean percentage of weight loss at 1, 2 and 3-years post-operative, and regression of obesity-related diseases were calculated. The Chi-Square Test and the McNemar test were used to compare unpaired and paired nominal data, respectively.

Results: A total of 8043 patients were entered into the bariatric registry between April 2010-March 2015.  Thirty-day mortality was rare (<0.075%) and showed no significant difference between years (Table 1).  Three-month post-operative complication rates significantly decreased with time (Table 1).  The mean percentage of weight loss at 1, 2, and 3 years postoperative showed stability at 33.2% (9.0 SD), 34.1% (10.1 SD), and 32.7% (10.1 SD), respectively.   Finally, significant regression in obesity-related comorbidities was demonstrated at 1-year postoperative, and showed continued improvement at 2-years postoperative.

  2010/11 (N=268) 2011/12 (N=1192) 2012/13 (N=2405) 2013/14 (N=2405) 2014/15 (N=1739)
Standardization None Partial Partial Full Full
Mortality (%) 0.0 0.0 0.2 0.1 0.0
3-month Complication Rate (%) 20.2 23.5 18.6* 17.1 13.2*

Table 1: Mortality and 3-month complication rate by year of surgery and degree of standardization (* Chi-Square Test (p<0.05))

Conclusion:  Evidence indicates the implementation of a standardized preoperative assessment, patient selection, operative approach and peri and post-operative care has resulted in improvements in complication rates and supported prolonged weight loss and regression of obesity-related diseases in patients undergoing bariatric surgery in Ontario.

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