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.