Skip to main content

Advertisement

SpringerLink
Log in

The impact of a standardized program on short and long-term outcomes in bariatric surgery

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

The purpose of this study was to determine whether there has been an improvement in short- and long-term clinical outcomes since 2010, when the Ontario Bariatric Network led a province-wide initiative to establish a standardized system of care for bariatric patients. The system includes nine bariatric centers, a centralized referral system, and a research registry. Standardization of procedures has progressed yearly, including guidelines for preoperative assessment and perioperative care.

Methods and procedures

Analysis of the OBN registry data was performed by fiscal year between April 2010 and March 2015. Three-month overall postoperative complication rates and 30 day postoperative mortality were calculated. The mean percentage of weight loss at 1, 2, and 3 years postoperative, and regression of obesity-related diseases were calculated. The analysis of continuous and nominal data was performed using ANOVA, Chi-square, and McNemar’s testing. A multiple logistic regression analysis was performed for factors affecting postoperative complication rate.

Results

Eight thousand and forty-three patients were included in the bariatric registry between April 2010 and March 2015. Thirty-day mortality was rare (<0.075 %) and showed no significant difference between years. Three-month overall postoperative complication rates significantly decreased with standardization (p < 0.001), as did intra-operative complication rates (p < −0.001). Regression analysis demonstrated increasing standardization to be a predictor of 3 month complication rate OR of 0.59 (95 %CI 0.41–0.85, p = 0.00385). 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. Sustained regression in obesity-related comorbidities was demonstrated at 1, 2, and 3 years postoperative.

Conclusion

Evidence indicates the implementation of a standardized system of bariatric care has contributed to improvements in complication rates and supported prolonged weight loss and regression of obesity-related diseases in patients undergoing bariatric surgery in Ontario.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Muliany EC (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980−2013. Lancet 384:766–781

    Article  PubMed  PubMed Central  Google Scholar 

  2. Navaneelan T, Janz T (2014) Adjusting the scales: obesity in the canadian population after correcting for respondent bias. Health at a glance. http://www.statcan.gc.ca/pub/82-624-x/2014001/article/11922-eng.pdf. May 2014. Accessed 20 December 2015

  3. Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, Rimm E, Colditz GA (2001) Impact of overweight on the risk of developing common chronic diseases during a 10 year period. Arch Intern Med 161:1581–1586

    Article  CAS  PubMed  Google Scholar 

  4. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, Hollenbeck A, Leitzmann MF (2006) Overweight, obesity and mortality from cancer in a large prospective cohort of persons 50–71 years old. N Engl J Med 355:763–778

    Article  CAS  PubMed  Google Scholar 

  5. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348:1625–1638

    Article  PubMed  Google Scholar 

  6. Hu FB, Stampfer MJ, Manson JE, Grodstein F, Colditz GA, Speizer FE, Willett WC (2000) Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women. N Engl J Med 343:530–537

    Article  CAS  PubMed  Google Scholar 

  7. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW (1999) Body-mass index and mortality in a prospective cohort of US adults. N Engl J Med 342:1097–1105

    Article  Google Scholar 

  8. Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, Rimm E, Colditz GA (2001) Impact of overweight on the risk of developing common chronic diseases during a 10 year period. Arch Intern Med 161:1581–1586

    Article  CAS  PubMed  Google Scholar 

  9. Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436

    Article  PubMed  Google Scholar 

  10. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean APH, MacLean L (2004) Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 240:416–424

    Article  PubMed  PubMed Central  Google Scholar 

  11. Christou NV, Lieberman M, Sampalis F, Sampalis JS (2008) Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis 4:691–697

    Article  PubMed  Google Scholar 

  12. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C (2007) Effects of bariatric surgery on mortality in Swedish obesity subjects. N Engl J Med 357:741–752

    Article  PubMed  Google Scholar 

  13. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, LaMonte MJ, Stroup AM, Hunt SC (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761

    Article  CAS  PubMed  Google Scholar 

  14. Zevin B, Aggarwal R, Grantcharov TP (2012) Volume-outcome association in bariatric surgery: a systematic review. Ann Surg 256:60–71

    Article  PubMed  Google Scholar 

  15. Hollenbeak CS, Rogers AM, Barrus B, Wadiwala I, Cooney RN (2008) Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery 144:736–743

    Article  PubMed  Google Scholar 

  16. Morton JM, Garg T, Nguyen N (2014) Does hospital accreditation impact bariatric surgery safety? Ann Surg 250:504–509

    Article  Google Scholar 

  17. DeMaria EJ, Pate V, Warthen M, Winegar DA (2010) Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis 6:347–355

    Article  PubMed  Google Scholar 

  18. Nguyen N, Higa K, Wilson S (2005) Improving the quality of care in bariatric surgery: the volume and outcome relationship. Adv Surg 39:181–191

    Article  PubMed  Google Scholar 

  19. Kohn GP, Galanko JA, Overby DW, Farrell TM (2010) High case volumes and surgical fel lowships are associated with improved outcomes for bariatric surgery patients: a justification of current credentialing initiatives for practice and training. J Am Coll Surg 210:909–918

    Article  PubMed  PubMed Central  Google Scholar 

  20. Donabedian A (1988) The quality of care. How can it be assessed? Jama 60:1743–1748

    Article  Google Scholar 

  21. Statistics Canada 2015. http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo02a-eng.htm

  22. Gastrointestinal surgery for severe obesity (from NIH Consens Dev Conf Consens Statement 1991 Mar 25–27; 9(1))

  23. Kang X, Zurita-Macias L, Hong D, Cadeddu M, Anvari M, Gmora S (2016) A comparison of 30 day versus 90 day proton pump inhibitor therapy in prevention of marginal ulcers after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relt Dis. doi:10.1016/j.soard.2015.11.010

    Google Scholar 

  24. Sarkhosh K, Switzer NJ, El-Hadi M, Birch D, Shi X, Karmali S (2013) The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg 23:414–423

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Kassandra O’Brian for her contribution.

Author information

Authors and Affiliations

  1. Division of General Surgery, St Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Lisa N. F. Aird, Dennis Hong, Scott Gmora & Mehran Anvari

  2. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Lisa N. F. Aird, Dennis Hong, Scott Gmora & Mehran Anvari

  3. Centre for Minimal Access Surgery, Hamilton, ON, Canada

    Lisa N. F. Aird, Dennis Hong, Scott Gmora & Mehran Anvari

  4. Centre for Surgical Invention and Innovation, Hamilton, ON, Canada

    Ruth Breau

Authors
  1. Lisa N. F. Aird
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dennis Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Gmora
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ruth Breau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehran Anvari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa N. F. Aird.

Ethics declarations

Disclosures

Dr. Lisa N. F Aird, Dr. Dennis Hong, Dr. Scott Gmora, Ruth Breau, Dr. Mehran Anvari do not have any conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aird, L.N.F., Hong, D., Gmora, S. et al. The impact of a standardized program on short and long-term outcomes in bariatric surgery. Surg Endosc 31, 801–808 (2017). https://doi.org/10.1007/s00464-016-5035-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5035-2

Keywords

Search

Navigation